Systems and methods related to robotic guidance in surgery

ABSTRACT

A surgical implant planning computer positions an implant device relative to a bone of a patient. An initial image of a bone is obtained. An initial location data structure is obtained that contains data defining mapping between locations on the implant device and corresponding locations relative to the bone in the initial image. A target image of the bone of the patient is obtained. A transformation matrix is generated that transforms a contour of a portion of the bone in the initial image to satisfy a defined rule for conforming to a contour of a corresponding portion of the bone in the target image. A transformed location data structure is generated based on applying the transformation matrix to the initial location data structure. A graphical representation of the implant device is displayed overlaid at locations on the target image of the bone determined based on the transformed location data structure.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part application of U.S. patentapplication Ser. No. 15/609,334 filed on May 31, 2017 which iscontinuation-in-part of U.S. patent application Ser. No. 15/157,444filed on May 18, 2016, which is a continuation in part of U.S. patentapplication Ser. No. 15/095,883, filed Apr. 11, 2016, which is acontinuation-in-part of U.S. patent application Ser. No. 14/062,707,filed on Oct. 24, 2013, which is a continuation-in-part application ofU.S. patent application Ser. No. 13/924,505, filed on Jun. 21, 2013,which claims priority to provisional application No. 61/662,702 filed onJun. 21, 2012 and claims priority to provisional application No.61/800,527 filed on Mar. 15, 2013, and claims priority to provisionalapplication 62/615,492 filed on Jan. 10, 2018, which are incorporate intheir entirety herein.

FIELD OF THE INVENTION

The present disclosure relates to medical devices, and moreparticularly, surgical robotic systems and related methods and devices.

BACKGROUND

Position recognition systems for robot assisted surgeries are used todetermine the position of and track a particular object in 3-dimensions(3D). In robot assisted surgeries, for example, certain objects, such assurgical instruments, need to be tracked with a high degree of precisionas the instrument is being positioned and moved by a robot or by aphysician, for example.

Infrared signal based position recognition systems may use passiveand/or active sensors or markers for tracking the objects. In passivesensors or markers, objects to be tracked may include passive sensors,such as reflective spherical balls, which are positioned at strategiclocations on the object to be tracked. Infrared transmitters transmit asignal, and the reflective spherical balls reflect the signal to aid indetermining the position of the object in 3D. In active sensors ormarkers, the objects to be tracked include active infrared transmitters,such as light emitting diodes (LEDs), and thus generate their owninfrared signals for 3D detection.

With either active or passive tracking sensors, the system thengeometrically resolves the 3-dimensional position of the active and/orpassive sensors based on information from or with respect to one or moreof the infrared cameras, digital signals, known locations of the activeor passive sensors, distance, the time it took to receive the responsivesignals, other known variables, or a combination thereof.

Position feedback is thereby used to precisely guide movement of roboticarms and tools relative to a patients' surgical site. Currently,development of a surgical plan for the desired locations where screws,tools, or other surgical implant devices are to be implanted when usinga surgical robot is performed manually by a surgeon. A surgeon analyzesa patient's medical image and may mark up the image to create a surgicalplan. Although each patient is different, they share many similarities.Therefore, the process of marking up an image to create a surgical planneed not start from scratch for each case. These surgical systems couldbenefit from a more automated, rapid and accurate process of planning ofthe characteristics of a surgical implant device that is to be implantedinto a particular bone and planning of the precise location, angle ofentry, and depth of implantation of the device. Such a process could bebased on successful surgical plans created for previous patients.

SUMMARY

Various embodiments of the present disclosure are directed to a surgicalsystem that allows auto-generation of a surgical plan and/or enables asurgeon to develop a surgical plan for implanting a surgical implantdevice with respect to a bone shown in one medical image, and thatautomatically transforms the surgical plan for use in implanting thesurgical implant device into a bone that is shown in another medicalimage. In some embodiments, a surgeon can plan implantation of theimplant device relative to an initial image of a bone, which maycorrespond to an earlier image of this or another patient or maycorrespond to a general surgical bone model. When a target image of thepatient's bone is then obtained, such as during surgery or preparation,the surgical system can generate a transformation matrix related totransforming one or more bone contours shown in the initial image toconform to corresponding one or more bone contours in the target image.The surgical system then uses the transformation matrix to transform thesurgical plan that was developed relative to the initial image to now berelative to the target image. The location, angle of entry, and depth ofimplantation of the implant device and/or sizing of the implantationdevice that was earlier specified with respect to the bone shown in theinitial image can thereby be transformed relative to the bone shown inthe target image. The transformed surgical plan can be displayed forreview by the surgeon and/or can be provided to a surgical roboticsystem to control positioning of a surgical end-effector of the surgicalrobotic system relative to the bone of the patient.

According to some embodiments of inventive concepts, a method isprovided to operate a surgical implant planning computer for positioninga surgical implant device relative to a bone of a patient. An initialimage of a bone is obtained. An initial location data structure isobtained that contains data defining mapping between a set of locationson the surgical implant device and a corresponding set of locationsrelative to the bone in the initial image. A target image of the bone ofthe patient is obtained. A transformation matrix is generated thattransforms a contour of a portion of the bone in the initial image tosatisfy a defined rule for conforming to a contour of a correspondingportion of the bone in the target image. A transformed location datastructure is generated based on applying the transformation matrix tothe initial location data structure. A graphical representation of thesurgical implant device is displayed overlaid at locations on the targetimage of the bone determined based on the transformed location datastructure.

In some further embodiments, the transformed location data structure isprovided to a surgical robotic system to control positioning of asurgical end-effector of the surgical robotic system relative to alocation on the bone of the patient based on data of the transformedlocation data structure. Locations that are defined by the transformedlocation data structure in a reference coordinate system of the targetimage of the bone can be transformed to another reference coordinatesystem of the surgical end-effector. Movement of the surgicalend-effector by the surgical robotic system to position the surgicalend-effector relative to the location on the bone of the patient can becontrolled based on the transformed locations to facilitate implantationof the surgical implant device in the bone of the patient.

Corresponding surgical implant planning computers, surgical systems, andcomputer program products are disclosed.

Still other methods and corresponding surgical implant planningcomputers, surgical systems, and computer program products according toembodiments of the inventive subject matter will be or become apparentto one with skill in the art upon review of the following drawings anddetailed description. It is intended that all such methods, surgicalimplant planning computers, surgical systems, and computer programproducts be included within this description, be within the scope of thepresent inventive subject matter, and be protected by the accompanyingclaims. Moreover, it is intended that all embodiments disclosed hereincan be implemented separately or combined in any way and/or combination.

DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the disclosure and are incorporated in a constitute apart of this application, illustrate certain non-limiting embodiments ofinventive concepts. In the drawings:

FIG. 1 is an overhead view of a potential arrangement for locations ofthe robotic system, patient, surgeon, and other medical personnel duringa surgical procedure;

FIG. 2 illustrates the robotic system including positioning of thesurgical robot and the camera relative to the patient according to oneembodiment;

FIG. 3 illustrates a surgical robotic system in accordance with anexemplary embodiment;

FIG. 4 illustrates a portion of a surgical robot in accordance with anexemplary embodiment;

FIG. 5 illustrates a block diagram of a surgical robot in accordancewith an exemplary embodiment;

FIG. 6 illustrates a surgical robot in accordance with an exemplaryembodiment;

FIGS. 7A-7C illustrate an end-effector in accordance with an exemplaryembodiment;

FIG. 8 illustrates a surgical instrument and the end-effector, beforeand after, inserting the surgical instrument into the guide tube of theend-effector according to one embodiment;

FIGS. 9A-9C illustrate portions of an end-effector and robot arm inaccordance with an exemplary embodiment;

FIG. 10 illustrates a dynamic reference array, an imaging array, andother components in accordance with an exemplary embodiment;

FIG. 11 illustrates a method of registration in accordance with anexemplary embodiment;

FIG. 12A-12B illustrate embodiments of imaging devices according toexemplary embodiments;

FIG. 13A illustrates a portion of a robot including the robot arm and anend-effector in accordance with an exemplary embodiment;

FIG. 13B is a close-up view of the end-effector, with a plurality oftracking markers rigidly affixed thereon, shown in FIG. 13A;

FIG. 13C is a tool or instrument with a plurality of tracking markersrigidly affixed thereon according to one embodiment;

FIG. 14A is an alternative version of an end-effector with moveabletracking markers in a first configuration;

FIG. 14B is the end-effector shown in FIG. 14A with the moveabletracking markers in a second configuration;

FIG. 14C shows the template of tracking markers in the firstconfiguration from FIG. 14A;

FIG. 14D shows the template of tracking markers in the secondconfiguration from FIG. 14B;

FIG. 15A shows an alternative version of the end-effector having only asingle tracking marker affixed thereto;

FIG. 15B shows the end-effector of FIG. 15A with an instrument disposedthrough the guide tube;

FIG. 15C shows the end-effector of FIG. 15A with the instrument in twodifferent positions, and the resulting logic to determine if theinstrument is positioned within the guide tube or outside of the guidetube;

FIG. 15D shows the end-effector of FIG. 15A with the instrument in theguide tube at two different frames and its relative distance to thesingle tracking marker on the guide tube;

FIG. 15E shows the end-effector of FIG. 15A relative to a coordinatesystem;

FIG. 16 is a block diagram of a method for navigating and moving theend-effector of the robot to a desired target trajectory;

FIGS. 17A-17B depict an instrument for inserting an expandable implanthaving fixed and moveable tracking markers in contracted and expandedpositions, respectively;

FIGS. 18A-18B depict an instrument for inserting an articulating implanthaving fixed and moveable tracking markers in insertion and angledpositions, respectively;

FIG. 19A depicts an embodiment of a robot with interchangeable oralternative end-effectors;

FIG. 19B depicts an embodiment of a robot with an instrument styleend-effector coupled thereto;

FIG. 20 illustrates a block diagram of a surgical system including asurgical implant planning computer connected to a surgical roboticsystem that operate in accordance with some exemplary embodiments;

FIG. 21 depicts a set of images that can be displayed on a displaydevice and related operations performed by the surgical implant planningcomputer to generate a transformation matrix that transforms a surgicalplan for implanting a surgical implant device relative to a bone in aninitial image for overlay on a bone in a target image, in accordancewith some exemplary embodiments;

FIGS. 22 and 23 illustrate flowcharts of operations by the surgicalimplant planning computer in accordance with some exemplary embodiments;

FIG. 24 depicts a set of images of bones with an overlaid surgicalimplant device that can be displayed on a display device via operationsin accordance with some exemplary embodiments;

FIG. 25 illustrate flowcharts of operations by the surgical implantplanning computer to adjust a location of a surgical implant devicerelative to the bones in the images depicted in FIG. 24, in accordancewith some exemplary embodiments; and

FIG. 26 illustrates a block diagram of components of a surgical implantplanning computer that are configured to operate in accordance with someexemplary embodiments.

DETAILED DESCRIPTION

The following discussion is presented to enable a person skilled in theart to make and use embodiments of the present disclosure. Variousmodifications to the illustrated embodiments will be readily apparent tothose skilled in the art, and the principles herein can be applied toother embodiments and applications without departing from embodiments ofthe present disclosure. Thus, the embodiments are not intended to belimited to embodiments shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures, in which like elements in different figures have like referencenumerals. The figures, which are not necessarily to scale, depictselected embodiments and are not intended to limit the scope of theembodiments. Skilled artisans will recognize the examples providedherein have many useful alternatives and fall within the scope of theembodiments.

As explained above, a surgeon may develop a surgical plan by analyzing apatient's medical image and marking up the image to create the surgicalplan for desired locations where screws, tools, or other surgicalimplant devices are to be implanted when using a surgical robot thatassists with implanting the devices. When using a surgical roboticsystem, a desired screw location may be planned preoperatively using acomputerized interface. In this interface, the surgeon scrolls throughor otherwise manipulates views of the patient's medical images, such asCT scan, x-ray, or MRI and positions graphic objects representing thedesired locations of screws as overlays on a displayed medical image ofa bone. The system stores the planned screw locations in system memory,typically by storing the x,y,z Cartesian coordinates of the tip and taillocations of each screw in the coordinate system of the volumetric scanof the medical image, or in the case of fluoroscopic guidance, savingtip and tail location coordinates in the coordinate system through whichthe fluoro shot images are projected. Later, when the robot isactivated, the coordinate system in which the screw locations have beenplanned is registered with the coordinate system of the tracking camerasand the robot moves to the planned locations, holding a guide tube forpreparation of screw holes and insertion of screws.

In accordance with various embodiments disclosed herein, the surgicalplanning process is improved by providing a surgical implant planningcomputer that automatically predicts desired locations of screws and/orother surgical implant devices before the surgeon views the patient'simages and can incorporate the surgeon's preferences regarding screw orother device placement (preferred depth, preferred angle, etc.) into anautomatic predictive surgical plan with respect to an initial medicalimage. Alternatively or additionally, the surgical implant planningcomputer obtains an initial surgical plan developed by a surgeon forimplanting a screw or other implant device with respect to the initialmedical image. The system transforms the automatic predictive surgicalplan and/or the surgeon's initial surgical plan made with respect to theinitial medical image to a transformed plan for use in implanting thesurgical implant device into a bone that is shown in a target medicalimage. Such automatic planning can reduce the time required for thesurgery and increase precision of planning.

Although various embodiments are described in the context of developinga surgical plan for implanting screws into a bone, this disclosure isnot limited thereto. Embodiments disclosed herein can be used to planthe implantation of any type of surgical implant device into a bone,tissue, cartilage, or other anatomical structure.

An example surgical robotic system is initially described below indetail followed by a description of various configurations andoperations of a surgical implant planning computer as part of a surgicalsystem in accordance with embodiments of the present disclosure.

Surgical Robotic System

Turning now to the drawing, FIGS. 1 and 2 illustrate a surgical robotsystem 100 in accordance with an exemplary embodiment. Surgical robotsystem 100 may include, for example, a surgical robot 102, one or morerobot arms 104, a base 106, a display 110, an end-effector 112, forexample, including a guide tube 114, and one or more tracking markers118. The surgical robot system 100 may include a patient tracking device116 also including one or more tracking markers 118, which is adapted tobe secured directly to the patient 210 (e.g., to a bone of the patient210). The surgical robot system 100 may also use a camera 200, forexample, positioned on a camera stand 202. The camera stand 202 can haveany suitable configuration to move, orient, and support the camera 200in a desired position. The camera 200 may include any suitable camera orcameras, such as one or more infrared cameras (e.g., bifocal orstereophotogrammetrical cameras), able to identify, for example, activeand passive tracking markers 118 (shown as part of patient trackingdevice 116 in FIG. 2 and shown by enlarged view in FIGS. 13A-13B) in agiven measurement volume viewable from the perspective of the camera200. The camera 200 may scan the given measurement volume and detect thelight that comes from the markers 118 in order to identify and determinethe position of the markers 118 in three-dimensions. For example, activemarkers 118 may include infrared-emitting markers that are activated byan electrical signal (e.g., infrared light emitting diodes (LEDs)),and/or passive markers 118 may include retro-reflective markers thatreflect infrared light (e.g., they reflect incoming IR radiation intothe direction of the incoming light), for example, emitted byilluminators on the camera 200 or other suitable device.

FIGS. 1 and 2 illustrate a potential configuration for the placement ofthe surgical robot system 100 in an operating room environment. Forexample, the robot 102 may be positioned near or next to patient 210.Although depicted near the head of the patient 210, it will beappreciated that the robot 102 can be positioned at any suitablelocation near the patient 210 depending on the area of the patient 210undergoing the operation. The camera 200 may be separated from the robotsystem 100 and positioned at the foot of patient 210. This locationallows the camera 200 to have a direct visual line of sight to thesurgical field 208. Again, it is contemplated that the camera 200 may belocated at any suitable position having line of sight to the surgicalfield 208. In the configuration shown, the surgeon 120 may be positionedacross from the robot 102, but is still able to manipulate theend-effector 112 and the display 110. A surgical assistant 126 may bepositioned across from the surgeon 120 again with access to both theend-effector 112 and the display 110. If desired, the locations of thesurgeon 120 and the assistant 126 may be reversed. The traditional areasfor the anesthesiologist 122 and the nurse or scrub tech 124 may remainunimpeded by the locations of the robot 102 and camera 200.

With respect to the other components of the robot 102, the display 110can be attached to the surgical robot 102 and in other exemplaryembodiments, display 110 can be detached from surgical robot 102, eitherwithin a surgical room with the surgical robot 102, or in a remotelocation. End-effector 112 may be coupled to the robot arm 104 andcontrolled by at least one motor. In exemplary embodiments, end-effector112 can comprise a guide tube 114, which is able to receive and orient asurgical instrument 608 (described further herein) used to performsurgery on the patient 210. As used herein, the term “end-effector” isused interchangeably with the terms “end-effectuator” and “effectuatorelement.” Although generally shown with a guide tube 114, it will beappreciated that the end-effector 112 may be replaced with any suitableinstrumentation suitable for use in surgery. In some embodiments,end-effector 112 can comprise any known structure for effecting themovement of the surgical instrument 608 in a desired manner.

The surgical robot 102 is able to control the translation andorientation of the end-effector 112. The robot 102 is able to moveend-effector 112 along x-, y-, and z-axes, for example. The end-effector112 can be configured for selective rotation about one or more of thex-, y-, and z-axis, and a Z Frame axis (such that one or more of theEuler Angles (e.g., roll, pitch, and/or yaw) associated withend-effector 112 can be selectively controlled). In some exemplaryembodiments, selective control of the translation and orientation ofend-effector 112 can permit performance of medical procedures withsignificantly improved accuracy compared to conventional robots thatuse, for example, a six degree of freedom robot arm comprising onlyrotational axes. For example, the surgical robot system 100 may be usedto operate on patient 210, and robot arm 104 can be positioned above thebody of patient 210, with end-effector 112 selectively angled relativeto the z-axis toward the body of patient 210.

In some exemplary embodiments, the position of the surgical instrument608 can be dynamically updated so that surgical robot 102 can be awareof the location of the surgical instrument 608 at all times during theprocedure. Consequently, in some exemplary embodiments, surgical robot102 can move the surgical instrument 608 to the desired position quicklywithout any further assistance from a physician (unless the physician sodesires). In some further embodiments, surgical robot 102 can beconfigured to correct the path of the surgical instrument 608 if thesurgical instrument 608 strays from the selected, preplanned trajectory.In some exemplary embodiments, surgical robot 102 can be configured topermit stoppage, modification, and/or manual control of the movement ofend-effector 112 and/or the surgical instrument 608. Thus, in use, inexemplary embodiments, a physician or other user can operate the system100, and has the option to stop, modify, or manually control theautonomous movement of end-effector 112 and/or the surgical instrument608. Further details of surgical robot system 100 including the controland movement of a surgical instrument 608 by surgical robot 102 can befound in co-pending U.S. patent application Ser. No. 13/924,505, whichis incorporated herein by reference in its entirety.

The robotic surgical system 100 can comprise one or more trackingmarkers 118 configured to track the movement of robot arm 104,end-effector 112, patient 210, and/or the surgical instrument 608 inthree dimensions. In exemplary embodiments, a plurality of trackingmarkers 118 can be mounted (or otherwise secured) thereon to an outersurface of the robot 102, such as, for example and without limitation,on base 106 of robot 102, on robot arm 104, and/or on the end-effector112. In exemplary embodiments, at least one tracking marker 118 of theplurality of tracking markers 118 can be mounted or otherwise secured tothe end-effector 112. One or more tracking markers 118 can further bemounted (or otherwise secured) to the patient 210. In exemplaryembodiments, the plurality of tracking markers 118 can be positioned onthe patient 210 spaced apart from the surgical field 208 to reduce thelikelihood of being obscured by the surgeon, surgical tools, or otherparts of the robot 102. Further, one or more tracking markers 118 can befurther mounted (or otherwise secured) to the surgical tools 608 (e.g.,a screw driver, dilator, implant inserter, or the like). Thus, thetracking markers 118 enable each of the marked objects (e.g., theend-effector 112, the patient 210, and the surgical tools 608) to betracked by the robot 102. In exemplary embodiments, system 100 can usetracking information collected from each of the marked objects tocalculate the orientation and location, for example, of the end-effector112, the surgical instrument 608 (e.g., positioned in the tube 114 ofthe end-effector 112), and the relative position of the patient 210.

The markers 118 may include radiopaque or optical markers. The markers118 may be suitably shaped include spherical, spheroid, cylindrical,cube, cuboid, or the like. In exemplary embodiments, one or more ofmarkers 118 may be optical markers. In some embodiments, the positioningof one or more tracking markers 118 on end-effector 112 can maximize theaccuracy of the positional measurements by serving to check or verifythe position of end-effector 112. Further details of surgical robotsystem 100 including the control, movement and tracking of surgicalrobot 102 and of a surgical instrument 608 can be found in U.S. patentpublication No. 2016/0242849, which is incorporated herein by referencein its entirety.

Exemplary embodiments include one or more markers 118 coupled to thesurgical instrument 608. In exemplary embodiments, these markers 118,for example, coupled to the patient 210 and surgical instruments 608, aswell as markers 118 coupled to the end-effector 112 of the robot 102 cancomprise conventional infrared light-emitting diodes (LEDs) or anOptotrak® diode capable of being tracked using a commercially availableinfrared optical tracking system such as Optotrak®. Optotrak® is aregistered trademark of Northern Digital Inc., Waterloo, Ontario,Canada. In other embodiments, markers 118 can comprise conventionalreflective spheres capable of being tracked using a commerciallyavailable optical tracking system such as Polaris Spectra. PolarisSpectra is also a registered trademark of Northern Digital, Inc. In anexemplary embodiment, the markers 118 coupled to the end-effector 112are active markers which comprise infrared light-emitting diodes whichmay be turned on and off, and the markers 118 coupled to the patient 210and the surgical instruments 608 comprise passive reflective spheres.

In exemplary embodiments, light emitted from and/or reflected by markers118 can be detected by camera 200 and can be used to monitor thelocation and movement of the marked objects. In alternative embodiments,markers 118 can comprise a radio-frequency and/or electromagneticreflector or transceiver and the camera 200 can include or be replacedby a radio-frequency and/or electromagnetic transceiver.

Similar to surgical robot system 100, FIG. 3 illustrates a surgicalrobot system 300 and camera stand 302, in a docked configuration,consistent with an exemplary embodiment of the present disclosure.Surgical robot system 300 may comprise a robot 301 including a display304, upper arm 306, lower arm 308, end-effector 310, vertical column312, casters 314, cabinet 316, tablet drawer 318, connector panel 320,control panel 322, and ring of information 324. Camera stand 302 maycomprise camera 326. These components are described in greater withrespect to FIG. 5. FIG. 3 illustrates the surgical robot system 300 in adocked configuration where the camera stand 302 is nested with the robot301, for example, when not in use. It will be appreciated by thoseskilled in the art that the camera 326 and robot 301 may be separatedfrom one another and positioned at any appropriate location during thesurgical procedure, for example, as shown in FIGS. 1 and 2.

FIG. 4 illustrates a base 400 consistent with an exemplary embodiment ofthe present disclosure. Base 400 may be a portion of surgical robotsystem 300 and comprise cabinet 316. Cabinet 316 may house certaincomponents of surgical robot system 300 including but not limited to abattery 402, a power distribution module 404, a platform interface boardmodule 406, a computer 408, a handle 412, and a tablet drawer 414. Theconnections and relationship between these components is described ingreater detail with respect to FIG. 5.

FIG. 5 illustrates a block diagram of certain components of an exemplaryembodiment of surgical robot system 300. Surgical robot system 300 maycomprise platform subsystem 502, computer subsystem 504, motion controlsubsystem 506, and tracking subsystem 532. Platform subsystem 502 mayfurther comprise battery 402, power distribution module 404, platforminterface board module 406, and tablet charging station 534. Computersubsystem 504 may further comprise computer 408, display 304, andspeaker 536. Motion control subsystem 506 may further comprise drivercircuit 508, motors 510, 512, 514, 516, 518, stabilizers 520, 522, 524,526, end-effector 310, and controller 538. Tracking subsystem 532 mayfurther comprise position sensor 540 and camera converter 542. System300 may also comprise a foot pedal 544 and tablet 546.

Input power is supplied to system 300 via a power source 548 which maybe provided to power distribution module 404. Power distribution module404 receives input power and is configured to generate different powersupply voltages that are provided to other modules, components, andsubsystems of system 300. Power distribution module 404 may beconfigured to provide different voltage supplies to platform interfacemodule 406, which may be provided to other components such as computer408, display 304, speaker 536, driver 508 to, for example, power motors512, 514, 516, 518 and end-effector 310, motor 510, ring 324, cameraconverter 542, and other components for system 300 for example, fans forcooling the electrical components within cabinet 316.

Power distribution module 404 may also provide power to other componentssuch as tablet charging station 534 that may be located within tabletdrawer 318. Tablet charging station 534 may be in wireless or wiredcommunication with tablet 546 for charging table 546. Tablet 546 may beused by a surgeon consistent with the present disclosure and describedherein.

Power distribution module 404 may also be connected to battery 402,which serves as temporary power source in the event that powerdistribution module 404 does not receive power from input power 548. Atother times, power distribution module 404 may serve to charge battery402 if necessary.

Other components of platform subsystem 502 may also include connectorpanel 320, control panel 322, and ring 324. Connector panel 320 mayserve to connect different devices and components to system 300 and/orassociated components and modules. Connector panel 320 may contain oneor more ports that receive lines or connections from differentcomponents. For example, connector panel 320 may have a ground terminalport that may ground system 300 to other equipment, a port to connectfoot pedal 544 to system 300, a port to connect to tracking subsystem532, which may comprise position sensor 540, camera converter 542, andcameras 326 associated with camera stand 302. Connector panel 320 mayalso include other ports to allow USB, Ethernet, HDMI communications toother components, such as computer 408.

Control panel 322 may provide various buttons or indicators that controloperation of system 300 and/or provide information regarding system 300.For example, control panel 322 may include buttons to power on or offsystem 300, lift or lower vertical column 312, and lift or lowerstabilizers 520-526 that may be designed to engage casters 314 to locksystem 300 from physically moving. Other buttons may stop system 300 inthe event of an emergency, which may remove all motor power and applymechanical brakes to stop all motion from occurring. Control panel 322may also have indicators notifying the user of certain system conditionssuch as a line power indicator or status of charge for battery 402.

Ring 324 may be a visual indicator to notify the user of system 300 ofdifferent modes that system 300 is operating under and certain warningsto the user.

Computer subsystem 504 includes computer 408, display 304, and speaker536. Computer 504 includes an operating system and software to operatesystem 300. Computer 504 may receive and process information from othercomponents (for example, tracking subsystem 532, platform subsystem 502,and/or motion control subsystem 506) in order to display information tothe user. Further, computer subsystem 504 may also include speaker 536to provide audio to the user.

Tracking subsystem 532 may include position sensor 504 and converter542. Tracking subsystem 532 may correspond to camera stand 302 includingcamera 326 as described with respect to FIG. 3. Position sensor 504 maybe camera 326. Tracking subsystem may track the location of certainmarkers that are located on the different components of system 300and/or instruments used by a user during a surgical procedure. Thistracking may be conducted in a manner consistent with the presentdisclosure including the use of infrared technology that tracks thelocation of active or passive elements, such as LEDs or reflectivemarkers, respectively. The location, orientation, and position ofstructures having these types of markers may be provided to computer 408which may be shown to a user on display 304. For example, a surgicalinstrument 608 having these types of markers and tracked in this manner(which may be referred to as a navigational space) may be shown to auser in relation to a three dimensional image of a patient's anatomicalstructure.

Motion control subsystem 506 may be configured to physically movevertical column 312, upper arm 306, lower arm 308, or rotateend-effector 310. The physical movement may be conducted through the useof one or more motors 510-518. For example, motor 510 may be configuredto vertically lift or lower vertical column 312. Motor 512 may beconfigured to laterally move upper arm 308 around a point of engagementwith vertical column 312 as shown in FIG. 3. Motor 514 may be configuredto laterally move lower arm 308 around a point of engagement with upperarm 308 as shown in FIG. 3. Motors 516 and 518 may be configured to moveend-effector 310 in a manner such that one may control the roll and onemay control the tilt, thereby providing multiple angles thatend-effector 310 may be moved. These movements may be achieved bycontroller 538 which may control these movements through load cellsdisposed on end-effector 310 and activated by a user engaging these loadcells to move system 300 in a desired manner.

Moreover, system 300 may provide for automatic movement of verticalcolumn 312, upper arm 306, and lower arm 308 through a user indicatingon display 304 (which may be a touchscreen input device) the location ofa surgical instrument or component on a three dimensional image of thepatient's anatomy on display 304. The user may initiate this automaticmovement by stepping on foot pedal 544 or some other input means.

FIG. 6 illustrates a surgical robot system 600 consistent with anexemplary embodiment. Surgical robot system 600 may compriseend-effector 602, robot arm 604, guide tube 606, instrument 608, androbot base 610. Instrument tool 608 may be attached to a tracking array612 including one or more tracking markers (such as markers 118) andhave an associated trajectory 614. Trajectory 614 may represent a pathof movement that instrument tool 608 is configured to travel once it ispositioned through or secured in guide tube 606, for example, a path ofinsertion of instrument tool 608 into a patient. In an exemplaryoperation, robot base 610 may be configured to be in electroniccommunication with robot arm 604 and end-effector 602 so that surgicalrobot system 600 may assist a user (for example, a surgeon) in operatingon the patient 210. Surgical robot system 600 may be consistent withpreviously described surgical robot system 100 and 300.

A tracking array 612 may be mounted on instrument 608 to monitor thelocation and orientation of instrument tool 608. The tracking array 612may be attached to an instrument 608 and may comprise tracking markers804. As best seen in FIG. 8, tracking markers 804 may be, for example,light emitting diodes and/or other types of reflective markers (e.g.,markers 118 as described elsewhere herein). The tracking devices may beone or more line of sight devices associated with the surgical robotsystem. As an example, the tracking devices may be one or more cameras200, 326 associated with the surgical robot system 100, 300 and may alsotrack tracking array 612 for a defined domain or relative orientationsof the instrument 608 in relation to the robot arm 604, the robot base610, end-effector 602, and/or the patient 210. The tracking devices maybe consistent with those structures described in connection with camerastand 302 and tracking subsystem 532.

FIGS. 7A, 7B, and 7C illustrate a top view, front view, and side view,respectively, of end-effector 602 consistent with an exemplaryembodiment. End-effector 602 may comprise one or more tracking markers702. Tracking markers 702 may be light emitting diodes or other types ofactive and passive markers, such as tracking markers 118 that have beenpreviously described. In an exemplary embodiment, the tracking markers702 are active infrared-emitting markers that are activated by anelectrical signal (e.g., infrared light emitting diodes (LEDs)). Thus,tracking markers 702 may be activated such that the infrared markers 702are visible to the camera 200, 326 or may be deactivated such that theinfrared markers 702 are not visible to the camera 200, 326. Thus, whenthe markers 702 are active, the end-effector 602 may be controlled bythe system 100, 300, 600, and when the markers 702 are deactivated, theend-effector 602 may be locked in position and unable to be moved by thesystem 100, 300, 600.

Markers 702 may be disposed on or within end-effector 602 in a mannersuch that the markers 702 are visible by one or more cameras 200, 326 orother tracking devices associated with the surgical robot system 100,300, 600. The camera 200, 326 or other tracking devices may trackend-effector 602 as it moves to different positions and viewing anglesby following the movement of tracking markers 702. The location ofmarkers 702 and/or end-effector 602 may be shown on a display 110, 304associated with the surgical robot system 100, 300, 600, for example,display 110 as shown in FIG. 2 and/or display 304 shown in FIG. 3. Thisdisplay 110, 304 may allow a user to ensure that end-effector 602 is ina desirable position in relation to robot arm 604, robot base 610, thepatient 210, and/or the user.

For example, as shown in FIG. 7A, markers 702 may be placed around thesurface of end-effector 602 so that a tracking device placed away fromthe surgical field 208 and facing toward the robot 102, 301 and thecamera 200, 326 is able to view at least 3 of the markers 702 through arange of common orientations of the end-effector 602 relative to thetracking device. For example, distribution of markers 702 in this wayallows end-effector 602 to be monitored by the tracking devices whenend-effector 602 is translated and rotated in the surgical field 208.

In addition, in exemplary embodiments, end-effector 602 may be equippedwith infrared (IR) receivers that can detect when an external camera200, 326 is getting ready to read markers 702. Upon this detection,end-effector 602 may then illuminate markers 702. The detection by theIR receivers that the external camera 200, 326 is ready to read markers702 may signal the need to synchronize a duty cycle of markers 702,which may be light emitting diodes, to an external camera 200, 326. Thismay also allow for lower power consumption by the robotic system as awhole, whereby markers 702 would only be illuminated at the appropriatetime instead of being illuminated continuously. Further, in exemplaryembodiments, markers 702 may be powered off to prevent interference withother navigation tools, such as different types of surgical instruments608.

FIG. 8 depicts one type of surgical instrument 608 including a trackingarray 612 and tracking markers 804. Tracking markers 804 may be of anytype described herein including but not limited to light emitting diodesor reflective spheres. Markers 804 are monitored by tracking devicesassociated with the surgical robot system 100, 300, 600 and may be oneor more of the line of sight cameras 200, 326. The cameras 200, 326 maytrack the location of instrument 608 based on the position andorientation of tracking array 612 and markers 804. A user, such as asurgeon 120, may orient instrument 608 in a manner so that trackingarray 612 and markers 804 are sufficiently recognized by the trackingdevice or camera 200, 326 to display instrument 608 and markers 804 on,for example, display 110 of the exemplary surgical robot system.

The manner in which a surgeon 120 may place instrument 608 into guidetube 606 of the end-effector 602 and adjust the instrument 608 isevident in FIG. 8. The hollow tube or guide tube 114, 606 of theend-effector 112, 310, 602 is sized and configured to receive at least aportion of the surgical instrument 608. The guide tube 114, 606 isconfigured to be oriented by the robot arm 104 such that insertion andtrajectory for the surgical instrument 608 is able to reach a desiredanatomical target within or upon the body of the patient 210. Thesurgical instrument 608 may include at least a portion of a generallycylindrical instrument. Although a screw driver is exemplified as thesurgical tool 608, it will be appreciated that any suitable surgicaltool 608 may be positioned by the end-effector 602. By way of example,the surgical instrument 608 may include one or more of a guide wire,cannula, a retractor, a drill, a reamer, a screw driver, an insertiontool, a removal tool, or the like. Although the hollow tube 114, 606 isgenerally shown as having a cylindrical configuration, it will beappreciated by those of skill in the art that the guide tube 114, 606may have any suitable shape, size and configuration desired toaccommodate the surgical instrument 608 and access the surgical site.

FIGS. 9A-9C illustrate end-effector 602 and a portion of robot arm 604consistent with an exemplary embodiment. End-effector 602 may furthercomprise body 1202 and clamp 1204. Clamp 1204 may comprise handle 1206,balls 1208, spring 1210, and lip 1212. Robot arm 604 may furthercomprise depressions 1214, mounting plate 1216, lip 1218, and magnets1220.

End-effector 602 may mechanically interface and/or engage with thesurgical robot system and robot arm 604 through one or more couplings.For example, end-effector 602 may engage with robot arm 604 through alocating coupling and/or a reinforcing coupling. Through thesecouplings, end-effector 602 may fasten with robot arm 604 outside aflexible and sterile barrier. In an exemplary embodiment, the locatingcoupling may be a magnetically kinematic mount and the reinforcingcoupling may be a five bar over center clamping linkage.

With respect to the locating coupling, robot arm 604 may comprisemounting plate 1216, which may be non-magnetic material, one or moredepressions 1214, lip 1218, and magnets 1220. Magnet 1220 is mountedbelow each of depressions 1214. Portions of clamp 1204 may comprisemagnetic material and be attracted by one or more magnets 1220. Throughthe magnetic attraction of clamp 1204 and robot arm 604, balls 1208become seated into respective depressions 1214. For example, balls 1208as shown in FIG. 9B would be seated in depressions 1214 as shown in FIG.9A. This seating may be considered a magnetically-assisted kinematiccoupling. Magnets 1220 may be configured to be strong enough to supportthe entire weight of end-effector 602 regardless of the orientation ofend-effector 602. The locating coupling may be any style of kinematicmount that uniquely restrains six degrees of freedom.

With respect to the reinforcing coupling, portions of clamp 1204 may beconfigured to be a fixed ground link and as such clamp 1204 may serve asa five bar linkage. Closing clamp handle 1206 may fasten end-effector602 to robot arm 604 as lip 1212 and lip 1218 engage clamp 1204 in amanner to secure end-effector 602 and robot arm 604. When clamp handle1206 is closed, spring 1210 may be stretched or stressed while clamp1204 is in a locked position. The locked position may be a position thatprovides for linkage past center. Because of a closed position that ispast center, the linkage will not open absent a force applied to clamphandle 1206 to release clamp 1204. Thus, in a locked positionend-effector 602 may be robustly secured to robot arm 604.

Spring 1210 may be a curved beam in tension. Spring 1210 may becomprised of a material that exhibits high stiffness and high yieldstrain such as virgin PEEK (poly-ether-ether-ketone). The linkagebetween end-effector 602 and robot arm 604 may provide for a sterilebarrier between end-effector 602 and robot arm 604 without impedingfastening of the two couplings.

The reinforcing coupling may be a linkage with multiple spring members.The reinforcing coupling may latch with a cam or friction basedmechanism. The reinforcing coupling may also be a sufficiently powerfulelectromagnet that will support fastening end-effector 102 to robot arm604. The reinforcing coupling may be a multi-piece collar completelyseparate from either end-effector 602 and/or robot arm 604 that slipsover an interface between end-effector 602 and robot arm 604 andtightens with a screw mechanism, an over center linkage, or a cammechanism.

Referring to FIGS. 10 and 11, prior to or during a surgical procedure,certain registration procedures may be conducted to track objects and atarget anatomical structure of the patient 210 both in a navigationspace and an image space. To conduct such registration, a registrationsystem 1400 may be used as illustrated in FIG. 10.

To track the position of the patient 210, a patient tracking device 116may include a patient fixation instrument 1402 to be secured to a rigidanatomical structure of the patient 210 and a dynamic reference base(DRB) 1404 may be securely attached to the patient fixation instrument1402. For example, patient fixation instrument 1402 may be inserted intoopening 1406 of dynamic reference base 1404. Dynamic reference base 1404may contain markers 1408 that are visible to tracking devices, such astracking subsystem 532. These markers 1408 may be optical markers orreflective spheres, such as tracking markers 118, as previouslydiscussed herein.

Patient fixation instrument 1402 is attached to a rigid anatomy of thepatient 210 and may remain attached throughout the surgical procedure.In an exemplary embodiment, patient fixation instrument 1402 is attachedto a rigid area of the patient 210, for example, a bone that is locatedaway from the targeted anatomical structure subject to the surgicalprocedure. In order to track the targeted anatomical structure, dynamicreference base 1404 is associated with the targeted anatomical structurethrough the use of a registration fixture that is temporarily placed onor near the targeted anatomical structure in order to register thedynamic reference base 1404 with the location of the targeted anatomicalstructure.

A registration fixture 1410 is attached to patient fixation instrument1402 through the use of a pivot arm 1412. Pivot arm 1412 is attached topatient fixation instrument 1402 by inserting patient fixationinstrument 1402 through an opening 1414 of registration fixture 1410.Pivot arm 1412 is attached to registration fixture 1410 by, for example,inserting a knob 1416 through an opening 1418 of pivot arm 1412.

Using pivot arm 1412, registration fixture 1410 may be placed over thetargeted anatomical structure and its location may be determined in animage space and navigation space using tracking markers 1420 and/orfiducials 1422 on registration fixture 1410. Registration fixture 1410may contain a collection of markers 1420 that are visible in anavigational space (for example, markers 1420 may be detectable bytracking subsystem 532). Tracking markers 1420 may be optical markersvisible in infrared light as previously described herein. Registrationfixture 1410 may also contain a collection of fiducials 1422, forexample, such as bearing balls, that are visible in an imaging space(for example, a three dimension CT image). As described in greaterdetail with respect to FIG. 11, using registration fixture 1410, thetargeted anatomical structure may be associated with dynamic referencebase 1404 thereby allowing depictions of objects in the navigationalspace to be overlaid on images of the anatomical structure. Dynamicreference base 1404, located at a position away from the targetedanatomical structure, may become a reference point thereby allowingremoval of registration fixture 1410 and/or pivot arm 1412 from thesurgical area.

FIG. 11 provides an exemplary method 1500 for registration consistentwith the present disclosure. Method 1500 begins at step 1502 wherein agraphical representation (or image(s)) of the targeted anatomicalstructure may be imported into system 100, 300 600, for example computer408. The graphical representation may be three dimensional CT or afluoroscope scan of the targeted anatomical structure of the patient 210which includes registration fixture 1410 and a detectable imagingpattern of fiducials 1420.

At step 1504, an imaging pattern of fiducials 1420 is detected andregistered in the imaging space and stored in computer 408. Optionally,at this time at step 1506, a graphical representation of theregistration fixture 1410 may be overlaid on the images of the targetedanatomical structure.

At step 1508, a navigational pattern of registration fixture 1410 isdetected and registered by recognizing markers 1420. Markers 1420 may beoptical markers that are recognized in the navigation space throughinfrared light by tracking subsystem 532 via position sensor 540. Thus,the location, orientation, and other information of the targetedanatomical structure is registered in the navigation space. Therefore,registration fixture 1410 may be recognized in both the image spacethrough the use of fiducials 1422 and the navigation space through theuse of markers 1420. At step 1510, the registration of registrationfixture 1410 in the image space is transferred to the navigation space.This transferal is done, for example, by using the relative position ofthe imaging pattern of fiducials 1422 compared to the position of thenavigation pattern of markers 1420.

At step 1512, registration of the navigation space of registrationfixture 1410 (having been registered with the image space) is furthertransferred to the navigation space of dynamic registration array 1404attached to patient fixture instrument 1402. Thus, registration fixture1410 may be removed and dynamic reference base 1404 may be used to trackthe targeted anatomical structure in both the navigation and image spacebecause the navigation space is associated with the image space.

At steps 1514 and 1516, the navigation space may be overlaid on theimage space and objects with markers visible in the navigation space(for example, surgical instruments 608 with optical markers 804). Theobjects may be tracked through graphical representations of the surgicalinstrument 608 on the images of the targeted anatomical structure.

FIGS. 12A-12B illustrate imaging devices 1304 that may be used inconjunction with robot systems 100, 300, 600 to acquire pre-operative,intra-operative, post-operative, and/or real-time image data of patient210. Any appropriate subject matter may be imaged for any appropriateprocedure using the imaging system 1304. The imaging system 1304 may beany imaging device such as imaging device 1306 and/or a C-arm 1308device. It may be desirable to take x-rays of patient 210 from a numberof different positions, without the need for frequent manualrepositioning of patient 210 which may be required in an x-ray system.As illustrated in FIG. 12A, the imaging system 1304 may be in the formof a C-arm 1308 that includes an elongated C-shaped member terminatingin opposing distal ends 1312 of the “C” shape. C-shaped member 1130 mayfurther comprise an x-ray source 1314 and an image receptor 1316. Thespace within C-arm 1308 of the arm may provide room for the physician toattend to the patient substantially free of interference from x-raysupport structure 1318. As illustrated in FIG. 12B, the imaging systemmay include imaging device 1306 having a gantry housing 1324 attached toa support structure imaging device support structure 1328, such as awheeled mobile cart 1330 with wheels 1332, which may enclose an imagecapturing portion, not illustrated. The image capturing portion mayinclude an x-ray source and/or emission portion and an x-ray receivingand/or image receiving portion, which may be disposed about one hundredand eighty degrees from each other and mounted on a rotor (notillustrated) relative to a track of the image capturing portion. Theimage capturing portion may be operable to rotate three hundred andsixty degrees during image acquisition. The image capturing portion mayrotate around a central point and/or axis, allowing image data ofpatient 210 to be acquired from multiple directions or in multipleplanes. Although certain imaging systems 1304 are exemplified herein, itwill be appreciated that any suitable imaging system may be selected byone of ordinary skill in the art.

Turning now to FIGS. 13A-13C, the surgical robot system 100, 300, 600relies on accurate positioning of the end-effector 112, 602, surgicalinstruments 608, and/or the patient 210 (e.g., patient tracking device116) relative to the desired surgical area. In the embodiments shown inFIGS. 13A-13C, the tracking markers 118, 804 are rigidly attached to aportion of the instrument 608 and/or end-effector 112.

FIG. 13A depicts part of the surgical robot system 100 with the robot102 including base 106, robot arm 104, and end-effector 112. The otherelements, not illustrated, such as the display, cameras, etc. may alsobe present as described herein. FIG. 13B depicts a close-up view of theend-effector 112 with guide tube 114 and a plurality of tracking markers118 rigidly affixed to the end-effector 112. In this embodiment, theplurality of tracking markers 118 are attached to the guide tube 112.FIG. 13C depicts an instrument 608 (in this case, a probe 608A) with aplurality of tracking markers 804 rigidly affixed to the instrument 608.As described elsewhere herein, the instrument 608 could include anysuitable surgical instrument, such as, but not limited to, guide wire,cannula, a retractor, a drill, a reamer, a screw driver, an insertiontool, a removal tool, or the like.

When tracking an instrument 608, end-effector 112, or other object to betracked in 3D, an array of tracking markers 118, 804 may be rigidlyattached to a portion of the tool 608 or end-effector 112. Preferably,the tracking markers 118, 804 are attached such that the markers 118,804 are out of the way (e.g., not impeding the surgical operation,visibility, etc.). The markers 118, 804 may be affixed to the instrument608, end-effector 112, or other object to be tracked, for example, withan array 612. Usually three or four markers 118, 804 are used with anarray 612. The array 612 may include a linear section, a cross piece,and may be asymmetric such that the markers 118, 804 are at differentrelative positions and locations with respect to one another. Forexample, as shown in FIG. 13C, a probe 608A with a 4-marker trackingarray 612 is shown, and FIG. 13B depicts the end-effector 112 with adifferent 4-marker tracking array 612.

In FIG. 13C, the tracking array 612 functions as the handle 620 of theprobe 608A. Thus, the four markers 804 are attached to the handle 620 ofthe probe 608A, which is out of the way of the shaft 622 and tip 624.Stereophotogrammetric tracking of these four markers 804 allows theinstrument 608 to be tracked as a rigid body and for the tracking system100, 300, 600 to precisely determine the position of the tip 624 and theorientation of the shaft 622 while the probe 608A is moved around infront of tracking cameras 200, 326.

To enable automatic tracking of one or more tools 608, end-effector 112,or other object to be tracked in 3D (e.g., multiple rigid bodies), themarkers 118, 804 on each tool 608, end-effector 112, or the like, arearranged asymmetrically with a known inter-marker spacing. The reasonfor asymmetric alignment is so that it is unambiguous which marker 118,804 corresponds to a particular location on the rigid body and whethermarkers 118, 804 are being viewed from the front or back, i.e.,mirrored. For example, if the markers 118, 804 were arranged in a squareon the tool 608 or end-effector 112, it would be unclear to the system100, 300, 600 which marker 118, 804 corresponded to which corner of thesquare. For example, for the probe 608A, it would be unclear whichmarker 804 was closest to the shaft 622. Thus, it would be unknown whichway the shaft 622 was extending from the array 612. Accordingly, eacharray 612 and thus each tool 608, end-effector 112, or other object tobe tracked should have a unique marker pattern to allow it to bedistinguished from other tools 608 or other objects being tracked.Asymmetry and unique marker patterns allow the system 100, 300, 600 todetect individual markers 118, 804 then to check the marker spacingagainst a stored template to determine which tool 608, end effector 112,or other object they represent. Detected markers 118, 804 can then besorted automatically and assigned to each tracked object in the correctorder. Without this information, rigid body calculations could not thenbe performed to extract key geometric information, for example, such astool tip 624 and alignment of the shaft 622, unless the user manuallyspecified which detected marker 118, 804 corresponded to which positionon each rigid body. These concepts are commonly known to those skilledin the methods of 3D optical tracking.

Turning now to FIGS. 14A-14D, an alternative version of an end-effector912 with moveable tracking markers 918A-918D is shown. In FIG. 14A, anarray with moveable tracking markers 918A-918D are shown in a firstconfiguration, and in FIG. 14B the moveable tracking markers 918A-918Dare shown in a second configuration, which is angled relative to thefirst configuration. FIG. 14C shows the template of the tracking markers918A-918D, for example, as seen by the cameras 200, 326 in the firstconfiguration of FIG. 14A; and FIG. 14D shows the template of trackingmarkers 918A-918D, for example, as seen by the cameras 200, 326 in thesecond configuration of FIG. 14B.

In this embodiment, 4-marker array tracking is contemplated wherein themarkers 918A-918D are not all in fixed position relative to the rigidbody and instead, one or more of the array markers 918A-918D can beadjusted, for example, during testing, to give updated information aboutthe rigid body that is being tracked without disrupting the process forautomatic detection and sorting of the tracked markers 918A-918D.

When tracking any tool, such as a guide tube 914 connected to the endeffector 912 of a robot system 100, 300, 600, the tracking array'sprimary purpose is to update the position of the end effector 912 in thecamera coordinate system. When using the rigid system, for example, asshown in FIG. 13B, the array 612 of reflective markers 118 rigidlyextend from the guide tube 114. Because the tracking markers 118 arerigidly connected, knowledge of the marker locations in the cameracoordinate system also provides exact location of the centerline, tip,and tail of the guide tube 114 in the camera coordinate system.Typically, information about the position of the end effector 112 fromsuch an array 612 and information about the location of a targettrajectory from another tracked source are used to calculate therequired moves that must be input for each axis of the robot 102 thatwill move the guide tube 114 into alignment with the trajectory and movethe tip to a particular location along the trajectory vector.

Sometimes, the desired trajectory is in an awkward or unreachablelocation, but if the guide tube 114 could be swiveled, it could bereached. For example, a very steep trajectory pointing away from thebase 106 of the robot 102 might be reachable if the guide tube 114 couldbe swiveled upward beyond the limit of the pitch (wrist up-down angle)axis, but might not be reachable if the guide tube 114 is attachedparallel to the plate connecting it to the end of the wrist. To reachsuch a trajectory, the base 106 of the robot 102 might be moved or adifferent end effector 112 with a different guide tube attachment mightbe exchanged with the working end effector. Both of these solutions maybe time consuming and cumbersome.

As best seen in FIGS. 14A and 14B, if the array 908 is configured suchthat one or more of the markers 918A-918D are not in a fixed positionand instead, one or more of the markers 918A-918D can be adjusted,swiveled, pivoted, or moved, the robot 102 can provide updatedinformation about the object being tracked without disrupting thedetection and tracking process. For example, one of the markers918A-918D may be fixed in position and the other markers 918A-918D maybe moveable; two of the markers 918A-918D may be fixed in position andthe other markers 918A-918D may be moveable; three of the markers918A-918D may be fixed in position and the other marker 918A-918D may bemoveable; or all of the markers 918A-918D may be moveable.

In the embodiment shown in FIGS. 14A and 14B, markers 918A, 918 B arerigidly connected directly to a base 906 of the end-effector 912, andmarkers 918C, 918D are rigidly connected to the tube 914. Similar toarray 612, array 908 may be provided to attach the markers 918A-918D tothe end-effector 912, instrument 608, or other object to be tracked. Inthis case, however, the array 908 is comprised of a plurality ofseparate components. For example, markers 918A, 918B may be connected tothe base 906 with a first array 908A, and markers 918C, 918D may beconnected to the guide tube 914 with a second array 908B. Marker 918Amay be affixed to a first end of the first array 908A and marker 918Bmay be separated a linear distance and affixed to a second end of thefirst array 908A. While first array 908 is substantially linear, secondarray 908B has a bent or V-shaped configuration, with respective rootends, connected to the guide tube 914, and diverging therefrom to distalends in a V-shape with marker 918C at one distal end and marker 918D atthe other distal end. Although specific configurations are exemplifiedherein, it will be appreciated that other asymmetric designs includingdifferent numbers and types of arrays 908A, 908B and differentarrangements, numbers, and types of markers 918A-918D are contemplated.

The guide tube 914 may be moveable, swivelable, or pivotable relative tothe base 906, for example, across a hinge 920 or other connector to thebase 906. Thus, markers 918C, 918D are moveable such that when the guidetube 914 pivots, swivels, or moves, markers 918C, 918D also pivot,swivel, or move. As best seen in FIG. 14A, guide tube 914 has alongitudinal axis 916 which is aligned in a substantially normal orvertical orientation such that markers 918A-918D have a firstconfiguration. Turning now to FIG. 14B, the guide tube 914 is pivoted,swiveled, or moved such that the longitudinal axis 916 is now angledrelative to the vertical orientation such that markers 918A-918D have asecond configuration, different from the first configuration.

In contrast to the embodiment described for FIGS. 14A-14D, if a swivelexisted between the guide tube 914 and the arm 104 (e.g., the wristattachment) with all four markers 918A-918D remaining attached rigidlyto the guide tube 914 and this swivel was adjusted by the user, therobotic system 100, 300, 600 would not be able to automatically detectthat the guide tube 914 orientation had changed. The robotic system 100,300, 600 would track the positions of the marker array 908 and wouldcalculate incorrect robot axis moves assuming the guide tube 914 wasattached to the wrist (the robot arm 104) in the previous orientation.By keeping one or more markers 918A-918D (e.g., two markers 918C, 918D)rigidly on the tube 914 and one or more markers 918A-918D (e.g., twomarkers 918A, 918B) across the swivel, automatic detection of the newposition becomes possible and correct robot moves are calculated basedon the detection of a new tool or end-effector 112, 912 on the end ofthe robot arm 104.

One or more of the markers 918A-918D are configured to be moved,pivoted, swiveled, or the like according to any suitable means. Forexample, the markers 918A-918D may be moved by a hinge 920, such as aclamp, spring, lever, slide, toggle, or the like, or any other suitablemechanism for moving the markers 918A-918D individually or incombination, moving the arrays 908A, 908B individually or incombination, moving any portion of the end-effector 912 relative toanother portion, or moving any portion of the tool 608 relative toanother portion.

As shown in FIGS. 14A and 14B, the array 908 and guide tube 914 maybecome reconfigurable by simply loosening the clamp or hinge 920, movingpart of the array 908A, 908B relative to the other part 908A, 908B, andretightening the hinge 920 such that the guide tube 914 is oriented in adifferent position. For example, two markers 918C, 918D may be rigidlyinterconnected with the tube 914 and two markers 918A, 918B may berigidly interconnected across the hinge 920 to the base 906 of theend-effector 912 that attaches to the robot arm 104. The hinge 920 maybe in the form of a clamp, such as a wing nut or the like, which can beloosened and retightened to allow the user to quickly switch between thefirst configuration (FIG. 14A) and the second configuration (FIG. 14B).

The cameras 200, 326 detect the markers 918A-918D, for example, in oneof the templates identified in FIGS. 14C and 14D. If the array 908 is inthe first configuration (FIG. 14A) and tracking cameras 200, 326 detectthe markers 918A-918D, then the tracked markers match Array Template 1as shown in FIG. 14C. If the array 908 is the second configuration (FIG.14B) and tracking cameras 200, 326 detect the same markers 918A-918D,then the tracked markers match Array Template 2 as shown in FIG. 14D.Array Template 1 and Array Template 2 are recognized by the system 100,300, 600 as two distinct tools, each with its own uniquely definedspatial relationship between guide tube 914, markers 918A-918D, androbot attachment. The user could therefore adjust the position of theend-effector 912 between the first and second configurations withoutnotifying the system 100, 300, 600 of the change and the system 100,300, 600 would appropriately adjust the movements of the robot 102 tostay on trajectory.

In this embodiment, there are two assembly positions in which the markerarray matches unique templates that allow the system 100, 300, 600 torecognize the assembly as two different tools or two different endeffectors. In any position of the swivel between or outside of these twopositions (namely, Array Template 1 and Array Template 2 shown in FIGS.14C and 14D, respectively), the markers 918A-918D would not match anytemplate and the system 100, 300, 600 would not detect any array presentdespite individual markers 918A-918D being detected by cameras 200, 326,with the result being the same as if the markers 918A-918D weretemporarily blocked from view of the cameras 200, 326. It will beappreciated that other array templates may exist for otherconfigurations, for example, identifying different instruments 608 orother end-effectors 112, 912, etc.

In the embodiment described, two discrete assembly positions are shownin FIGS. 14A and 14B. It will be appreciated, however, that there couldbe multiple discrete positions on a swivel joint, linear joint,combination of swivel and linear joints, pegboard, or other assemblywhere unique marker templates may be created by adjusting the positionof one or more markers 918A-918D of the array relative to the others,with each discrete position matching a particular template and defininga unique tool 608 or end-effector 112, 912 with different knownattributes. In addition, although exemplified for end effector 912, itwill be appreciated that moveable and fixed markers 918A-918D may beused with any suitable instrument 608 or other object to be tracked.

When using an external 3D tracking system 100, 300, 600 to track a fullrigid body array of three or more markers attached to a robot's endeffector 112 (for example, as depicted in FIGS. 13A and 13B), it ispossible to directly track or to calculate the 3D position of everysection of the robot 102 in the coordinate system of the cameras 200,326. The geometric orientations of joints relative to the tracker areknown by design, and the linear or angular positions of joints are knownfrom encoders for each motor of the robot 102, fully defining the 3Dpositions of all of the moving parts from the end effector 112 to thebase 116. Similarly, if a tracker were mounted on the base 106 of therobot 102 (not shown), it is likewise possible to track or calculate the3D position of every section of the robot 102 from base 106 to endeffector 112 based on known joint geometry and joint positions from eachmotor's encoder.

In some situations, it may be desirable to track the positions of allsegments of the robot 102 from fewer than three markers 118 rigidlyattached to the end effector 112. Specifically, if a tool 608 isintroduced into the guide tube 114, it may be desirable to track fullrigid body motion of the robot 902 with only one additional marker 118being tracked.

Turning now to FIGS. 15A-15E, an alternative version of an end-effector1012 having only a single tracking marker 1018 is shown. End-effector1012 may be similar to the other end-effectors described herein, and mayinclude a guide tube 1014 extending along a longitudinal axis 1016. Asingle tracking marker 1018, similar to the other tracking markersdescribed herein, may be rigidly affixed to the guide tube 1014. Thissingle marker 1018 can serve the purpose of adding missing degrees offreedom to allow full rigid body tracking and/or can serve the purposeof acting as a surveillance marker to ensure that assumptions aboutrobot and camera positioning are valid.

The single tracking marker 1018 may be attached to the robotic endeffector 1012 as a rigid extension to the end effector 1012 thatprotrudes in any convenient direction and does not obstruct thesurgeon's view. The tracking marker 1018 may be affixed to the guidetube 1014 or any other suitable location of on the end-effector 1012.When affixed to the guide tube 1014, the tracking marker 1018 may bepositioned at a location between first and second ends of the guide tube1014. For example, in FIG. 15A, the single tracking marker 1018 is shownas a reflective sphere mounted on the end of a narrow shaft 1017 thatextends forward from the guide tube 1014 and is positionedlongitudinally above a mid-point of the guide tube 1014 and below theentry of the guide tube 1014. This position allows the marker 1018 to begenerally visible by cameras 200, 326 but also would not obstruct visionof the surgeon 120 or collide with other tools or objects in thevicinity of surgery. In addition, the guide tube 1014 with the marker1018 in this position is designed for the marker array on any tool 608introduced into the guide tube 1014 to be visible at the same time asthe single marker 1018 on the guide tube 1014 is visible.

As shown in FIG. 15B, when a snugly fitting tool or instrument 608 isplaced within the guide tube 1014, the instrument 608 becomesmechanically constrained in 4 of 6 degrees of freedom. That is, theinstrument 608 cannot be rotated in any direction except about thelongitudinal axis 1016 of the guide tube 1014 and the instrument 608cannot be translated in any direction except along the longitudinal axis1016 of the guide tube 1014. In other words, the instrument 608 can onlybe translated along and rotated about the centerline of the guide tube1014. If two more parameters are known, such as (1) an angle of rotationabout the longitudinal axis 1016 of the guide tube 1014; and (2) aposition along the guide tube 1014, then the position of the endeffector 1012 in the camera coordinate system becomes fully defined.

Referring now to FIG. 15C, the system 100, 300, 600 should be able toknow when a tool 608 is actually positioned inside of the guide tube1014 and is not instead outside of the guide tube 1014 and justsomewhere in view of the cameras 200, 326. The tool 608 has alongitudinal axis or centerline 616 and an array 612 with a plurality oftracked markers 804. The rigid body calculations may be used todetermine where the centerline 616 of the tool 608 is located in thecamera coordinate system based on the tracked position of the array 612on the tool 608.

The fixed normal (perpendicular) distance D_(F) from the single marker1018 to the centerline or longitudinal axis 1016 of the guide tube 1014is fixed and is known geometrically, and the position of the singlemarker 1018 can be tracked. Therefore, when a detected distance D_(D)from tool centerline 616 to single marker 1018 matches the known fixeddistance D_(F) from the guide tube centerline 1016 to the single marker1018, it can be determined that the tool 608 is either within the guidetube 1014 (centerlines 616, 1016 of tool 608 and guide tube 1014coincident) or happens to be at some point in the locus of possiblepositions where this distance D_(D) matches the fixed distance D_(F).For example, in FIG. 15C, the normal detected distance D_(D) from toolcenterline 616 to the single marker 1018 matches the fixed distanceD_(F) from guide tube centerline 1016 to the single marker 1018 in bothframes of data (tracked marker coordinates) represented by thetransparent tool 608 in two positions, and thus, additionalconsiderations may be needed to determine when the tool 608 is locatedin the guide tube 1014.

Turning now to FIG. 15D, programmed logic can be used to look for framesof tracking data in which the detected distance D_(D) from toolcenterline 616 to single marker 1018 remains fixed at the correct lengthdespite the tool 608 moving in space by more than some minimum distancerelative to the single sphere 1018 to satisfy the condition that thetool 608 is moving within the guide tube 1014. For example, a firstframe F1 may be detected with the tool 608 in a first position and asecond frame F2 may be detected with the tool 608 in a second position(namely, moved linearly with respect to the first position). The markers804 on the tool array 612 may move by more than a given amount (e.g.,more than 5 mm total) from the first frame F1 to the second frame F2.Even with this movement, the detected distance D_(D) from the toolcenterline vector C′ to the single marker 1018 is substantiallyidentical in both the first frame F1 and the second frame F2.

Logistically, the surgeon 120 or user could place the tool 608 withinthe guide tube 1014 and slightly rotate it or slide it down into theguide tube 1014 and the system 100, 300, 600 would be able to detectthat the tool 608 is within the guide tube 1014 from tracking of thefive markers (four markers 804 on tool 608 plus single marker 1018 onguide tube 1014). Knowing that the tool 608 is within the guide tube1014, all 6 degrees of freedom may be calculated that define theposition and orientation of the robotic end effector 1012 in space.Without the single marker 1018, even if it is known with certainty thatthe tool 608 is within the guide tube 1014, it is unknown where theguide tube 1014 is located along the tool's centerline vector C′ and howthe guide tube 1014 is rotated relative to the centerline vector C′.

With emphasis on FIG. 15E, the presence of the single marker 1018 beingtracked as well as the four markers 804 on the tool 608, it is possibleto construct the centerline vector C′ of the guide tube 1014 and tool608 and the normal vector through the single marker 1018 and through thecenterline vector C′. This normal vector has an orientation that is in aknown orientation relative to the forearm of the robot distal to thewrist (in this example, oriented parallel to that segment) andintersects the centerline vector C′ at a specific fixed position. Forconvenience, three mutually orthogonal vectors k′, j′, i′ can beconstructed, as shown in FIG. 15E, defining rigid body position andorientation of the guide tube 1014. One of the three mutually orthogonalvectors k′ is constructed from the centerline vector C′, the secondvector j′ is constructed from the normal vector through the singlemarker 1018, and the third vector i′ is the vector cross product of thefirst and second vectors k′, j′. The robot's joint positions relative tothese vectors k′, j′, i′ are known and fixed when all joints are atzero, and therefore rigid body calculations can be used to determine thelocation of any section of the robot relative to these vectors k′, j′,i′ when the robot is at a home position. During robot movement, if thepositions of the tool markers 804 (while the tool 608 is in the guidetube 1014) and the position of the single marker 1018 are detected fromthe tracking system, and angles/linear positions of each joint are knownfrom encoders, then position and orientation of any section of the robotcan be determined.

In some embodiments, it may be useful to fix the orientation of the tool608 relative to the guide tube 1014. For example, the end effector guidetube 1014 may be oriented in a particular position about its axis 1016to allow machining or implant positioning. Although the orientation ofanything attached to the tool 608 inserted into the guide tube 1014 isknown from the tracked markers 804 on the tool 608, the rotationalorientation of the guide tube 1014 itself in the camera coordinatesystem is unknown without the additional tracking marker 1018 (ormultiple tracking markers in other embodiments) on the guide tube 1014.This marker 1018 provides essentially a “clock position” from −180° to+180° based on the orientation of the marker 1018 relative to thecenterline vector C′. Thus, the single marker 1018 can provideadditional degrees of freedom to allow full rigid body tracking and/orcan act as a surveillance marker to ensure that assumptions about therobot and camera positioning are valid.

FIG. 16 is a block diagram of a method 1100 for navigating and movingthe end-effector 1012 (or any other end-effector described herein) ofthe robot 102 to a desired target trajectory. Another use of the singlemarker 1018 on the robotic end effector 1012 or guide tube 1014 is aspart of the method 1100 enabling the automated safe movement of therobot 102 without a full tracking array attached to the robot 102. Thismethod 1100 functions when the tracking cameras 200, 326 do not moverelative to the robot 102 (i.e., they are in a fixed position), thetracking system's coordinate system and robot's coordinate system areco-registered, and the robot 102 is calibrated such that the positionand orientation of the guide tube 1014 can be accurately determined inthe robot's Cartesian coordinate system based only on the encodedpositions of each robotic axis.

For this method 1100, the coordinate systems of the tracker and therobot must be co-registered, meaning that the coordinate transformationfrom the tracking system's Cartesian coordinate system to the robot'sCartesian coordinate system is needed. For convenience, this coordinatetransformation can be a 4×4 matrix of translations and rotations that iswell known in the field of robotics. This transformation will be termedTcr to refer to “transformation—camera to robot”. Once thistransformation is known, any new frame of tracking data, which isreceived as x,y,z coordinates in vector form for each tracked marker,can be multiplied by the 4×4 matrix and the resulting x,y,z coordinateswill be in the robot's coordinate system. To obtain Tcr, a full trackingarray on the robot is tracked while it is rigidly attached to the robotat a location that is known in the robot's coordinate system, then knownrigid body methods are used to calculate the transformation ofcoordinates. It should be evident that any tool 608 inserted into theguide tube 1014 of the robot 102 can provide the same rigid bodyinformation as a rigidly attached array when the additional marker 1018is also read. That is, the tool 608 need only be inserted to anyposition within the guide tube 1014 and at any rotation within the guidetube 1014, not to a fixed position and orientation. Thus, it is possibleto determine Tcr by inserting any tool 608 with a tracking array 612into the guide tube 1014 and reading the tool's array 612 plus thesingle marker 1018 of the guide tube 1014 while at the same timedetermining from the encoders on each axis the current location of theguide tube 1014 in the robot's coordinate system.

Logic for navigating and moving the robot 102 to a target trajectory isprovided in the method 1100 of FIG. 16. Before entering the loop 1102,it is assumed that the transformation Tcr was previously stored. Thus,before entering loop 1102, in step 1104, after the robot base 106 issecured, greater than or equal to one frame of tracking data of a toolinserted in the guide tube while the robot is static is stored; and instep 1106, the transformation of robot guide tube position from cameracoordinates to robot coordinates Tcr is calculated from this static dataand previous calibration data. Tcr should remain valid as long as thecameras 200, 326 do not move relative to the robot 102. If the cameras200, 326 move relative to the robot 102, and Tcr needs to bere-obtained, the system 100, 300, 600 can be made to prompt the user toinsert a tool 608 into the guide tube 1014 and then automaticallyperform the necessary calculations.

In the flowchart of method 1100, each frame of data collected consistsof the tracked position of the DRB 1404 on the patient 210, the trackedposition of the single marker 1018 on the end effector 1014, and asnapshot of the positions of each robotic axis. From the positions ofthe robot's axes, the location of the single marker 1018 on the endeffector 1012 is calculated. This calculated position is compared to theactual position of the marker 1018 as recorded from the tracking system.If the values agree, it can be assured that the robot 102 is in a knownlocation. The transformation Tcr is applied to the tracked position ofthe DRB 1404 so that the target for the robot 102 can be provided interms of the robot's coordinate system. The robot 102 can then becommanded to move to reach the target.

After steps 1104, 1106, loop 1102 includes step 1108 receiving rigidbody information for DRB 1404 from the tracking system; step 1110transforming target tip and trajectory from image coordinates totracking system coordinates; and step 1112 transforming target tip andtrajectory from camera coordinates to robot coordinates (apply Tcr).Loop 1102 further includes step 1114 receiving a single stray markerposition for robot from tracking system; and step 1116 transforming thesingle stray marker from tracking system coordinates to robotcoordinates (apply stored Tcr). Loop 1102 also includes step 1118determining current location of the single robot marker 1018 in therobot coordinate system from forward kinematics. The information fromsteps 1116 and 1118 is used to determine step 1120 whether the straymarker coordinates from transformed tracked position agree with thecalculated coordinates being less than a given tolerance. If yes,proceed to step 1122, calculate and apply robot move to target x, y, zand trajectory. If no, proceed to step 1124, halt and require full arrayinsertion into guide tube 1014 before proceeding; step 1126 after arrayis inserted, recalculate Tcr; and then proceed to repeat steps 1108,1114, and 1118.

This method 1100 has advantages over a method in which the continuousmonitoring of the single marker 1018 to verify the location is omitted.Without the single marker 1018, it would still be possible to determinethe position of the end effector 1012 using Tcr and to send theend-effector 1012 to a target location but it would not be possible toverify that the robot 102 was actually in the expected location. Forexample, if the cameras 200, 326 had been bumped and Tcr was no longervalid, the robot 102 would move to an erroneous location. For thisreason, the single marker 1018 provides value with regard to safety.

For a given fixed position of the robot 102, it is theoreticallypossible to move the tracking cameras 200, 326 to a new location inwhich the single tracked marker 1018 remains unmoved since it is asingle point, not an array. In such a case, the system 100, 300, 600would not detect any error since there would be agreement in thecalculated and tracked locations of the single marker 1018. However,once the robot's axes caused the guide tube 1012 to move to a newlocation, the calculated and tracked positions would disagree and thesafety check would be effective.

The term “surveillance marker” may be used, for example, in reference toa single marker that is in a fixed location relative to the DRB 1404. Inthis instance, if the DRB 1404 is bumped or otherwise dislodged, therelative location of the surveillance marker changes and the surgeon 120can be alerted that there may be a problem with navigation. Similarly,in the embodiments described herein, with a single marker 1018 on therobot's guide tube 1014, the system 100, 300, 600 can continuously checkwhether the cameras 200, 326 have moved relative to the robot 102. Ifregistration of the tracking system's coordinate system to the robot'scoordinate system is lost, such as by cameras 200, 326 being bumped ormalfunctioning or by the robot malfunctioning, the system 100, 300, 600can alert the user and corrections can be made. Thus, this single marker1018 can also be thought of as a surveillance marker for the robot 102.

It should be clear that with a full array permanently mounted on therobot 102 (e.g., the plurality of tracking markers 702 on end-effector602 shown in FIGS. 7A-7C) such functionality of a single marker 1018 asa robot surveillance marker is not needed because it is not requiredthat the cameras 200, 326 be in a fixed position relative to the robot102, and Tcr is updated at each frame based on the tracked position ofthe robot 102. Reasons to use a single marker 1018 instead of a fullarray are that the full array is more bulky and obtrusive, therebyblocking the surgeon's view and access to the surgical field 208 morethan a single marker 1018, and line of sight to a full array is moreeasily blocked than line of sight to a single marker 1018.

Turning now to FIGS. 17A-17B and 18A-18B, instruments 608, such asimplant holders 608B, 608C, are depicted which include both fixed andmoveable tracking markers 804, 806. The implant holders 608B, 608C mayhave a handle 620 and an outer shaft 622 extending from the handle 620.The shaft 622 may be positioned substantially perpendicular to thehandle 620, as shown, or in any other suitable orientation. An innershaft 626 may extend through the outer shaft 622 with a knob 628 at oneend. Implant 10, 12 connects to the shaft 622, at the other end, at tip624 of the implant holder 608B, 608C using typical connection mechanismsknown to those of skill in the art. The knob 628 may be rotated, forexample, to expand or articulate the implant 10, 12. U.S. Pat. Nos.8,709,086 and 8,491,659, which are incorporated by reference herein,describe expandable fusion devices and methods of installation.

When tracking the tool 608, such as implant holder 608B, 608C, thetracking array 612 may contain a combination of fixed markers 804 andone or more moveable markers 806 which make up the array 612 or isotherwise attached to the implant holder 608B, 608C. The navigationarray 612 may include at least one or more (e.g., at least two) fixedposition markers 804, which are positioned with a known locationrelative to the implant holder instrument 608B, 608C. These fixedmarkers 804 would not be able to move in any orientation relative to theinstrument geometry and would be useful in defining where the instrument608 is in space. In addition, at least one marker 806 is present whichcan be attached to the array 612 or the instrument itself which iscapable of moving within a pre-determined boundary (e.g., sliding,rotating, etc.) relative to the fixed markers 804. The system 100, 300,600 (e.g., the software) correlates the position of the moveable marker806 to a particular position, orientation, or other attribute of theimplant 10 (such as height of an expandable interbody spacer shown inFIGS. 17A-17B or angle of an articulating interbody spacer shown inFIGS. 18A-18B). Thus, the system and/or the user can determine theheight or angle of the implant 10, 12 based on the location of themoveable marker 806.

In the embodiment shown in FIGS. 17A-17B, four fixed markers 804 areused to define the implant holder 608B and a fifth moveable marker 806is able to slide within a pre-determined path to provide feedback on theimplant height (e.g., a contracted position or an expanded position).FIG. 17A shows the expandable spacer 10 at its initial height, and FIG.17B shows the spacer 10 in the expanded state with the moveable marker806 translated to a different position. In this case, the moveablemarker 806 moves closer to the fixed markers 804 when the implant 10 isexpanded, although it is contemplated that this movement may be reversedor otherwise different. The amount of linear translation of the marker806 would correspond to the height of the implant 10. Although only twopositions are shown, it would be possible to have this as a continuousfunction whereby any given expansion height could be correlated to aspecific position of the moveable marker 806.

Turning now to FIGS. 18A-18B, four fixed markers 804 are used to definethe implant holder 608C and a fifth, moveable marker 806 is configuredto slide within a pre-determined path to provide feedback on the implantarticulation angle. FIG. 18A shows the articulating spacer 12 at itsinitial linear state, and FIG. 18B shows the spacer 12 in an articulatedstate at some offset angle with the moveable marker 806 translated to adifferent position. The amount of linear translation of the marker 806would correspond to the articulation angle of the implant 12. Althoughonly two positions are shown, it would be possible to have this as acontinuous function whereby any given articulation angle could becorrelated to a specific position of the moveable marker 806.

In these embodiments, the moveable marker 806 slides continuously toprovide feedback about an attribute of the implant 10, 12 based onposition. It is also contemplated that there may be discreet positionsthat the moveable marker 806 must be in which would also be able toprovide further information about an implant attribute. In this case,each discreet configuration of all markers 804, 806 correlates to aspecific geometry of the implant holder 608B, 608C and the implant 10,12 in a specific orientation or at a specific height. In addition, anymotion of the moveable marker 806 could be used for other variableattributes of any other type of navigated implant.

Although depicted and described with respect to linear movement of themoveable marker 806, the moveable marker 806 should not be limited tojust sliding as there may be applications where rotation of the marker806 or other movements could be useful to provide information about theimplant 10, 12. Any relative change in position between the set of fixedmarkers 804 and the moveable marker 806 could be relevant informationfor the implant 10, 12 or other device. In addition, although expandableand articulating implants 10, 12 are exemplified, the instrument 608could work with other medical devices and materials, such as spacers,cages, plates, fasteners, nails, screws, rods, pins, wire structures,sutures, anchor clips, staples, stents, bone grafts, biologics, cements,or the like.

Turning now to FIG. 19A, it is envisioned that the robot end-effector112 is interchangeable with other types of end-effectors 112. Moreover,it is contemplated that each end-effector 112 may be able to perform oneor more functions based on a desired surgical procedure. For example,the end-effector 112 having a guide tube 114 may be used for guiding aninstrument 608 as described herein. In addition, end-effector 112 may bereplaced with a different or alternative end-effector 112 that controlsa surgical device, instrument, or implant, for example.

The alternative end-effector 112 may include one or more devices orinstruments coupled to and controllable by the robot. By way ofnon-limiting example, the end-effector 112, as depicted in FIG. 19A, maycomprise a retractor (for example, one or more retractors disclosed inU.S. Pat. Nos. 8,992,425 and 8,968,363) or one or more mechanisms forinserting or installing surgical devices such as expandableintervertebral fusion devices (such as expandable implants exemplifiedin U.S. Pat. Nos. 8,845,734; 9,510,954; and 9,456,903), stand-aloneintervertebral fusion devices (such as implants exemplified in U.S. Pat.Nos. 9,364,343 and 9,480,579), expandable corpectomy devices (such ascorpectomy implants exemplified in U.S. Pat. Nos. 9,393,128 and9,173,747), articulating spacers (such as implants exemplified in U.S.Pat. No. 9,259,327), facet prostheses (such as devices exemplified inU.S. Pat. No. 9,539,031), laminoplasty devices (such as devicesexemplified in U.S. Pat. No. 9,486,253), spinous process spacers (suchas implants exemplified in U.S. Pat. No. 9,592,082), inflatables,fasteners including polyaxial screws, uniplanar screws, pedicle screws,posted screws, and the like, bone fixation plates, rod constructs andrevision devices (such as devices exemplified in U.S. Pat. No.8,882,803), artificial and natural discs, motion preserving devices andimplants, spinal cord stimulators (such as devices exemplified in U.S.Pat. No. 9,440,076), and other surgical devices. The end-effector 112may include one or instruments directly or indirectly coupled to therobot for providing bone cement, bone grafts, living cells,pharmaceuticals, or other deliverable to a surgical target. Theend-effector 112 may also include one or more instruments designed forperforming a discectomy, kyphoplasty, vertebrostenting, dilation, orother surgical procedure.

The end-effector itself and/or the implant, device, or instrument mayinclude one or more markers 118 such that the location and position ofthe markers 118 may be identified in three-dimensions. It iscontemplated that the markers 118 may include active or passive markers118, as described herein, that may be directly or indirectly visible tothe cameras 200. Thus, one or more markers 118 located on an implant 10,for example, may provide for tracking of the implant 10 before, during,and after implantation.

As shown in FIG. 19B, the end-effector 112 may include an instrument 608or portion thereof that is coupled to the robot arm 104 (for example,the instrument 608 may be coupled to the robot arm 104 by the couplingmechanism shown in FIGS. 9A-9C) and is controllable by the robot system100. Thus, in the embodiment shown in FIG. 19B, the robot system 100 isable to insert implant 10 into a patient and expand or contract theexpandable implant 10. Accordingly, the robot system 100 may beconfigured to assist a surgeon or to operate partially or completelyindependently thereof. Thus, it is envisioned that the robot system 100may be capable of controlling each alternative end-effector 112 for itsspecified function or surgical procedure.

System with Surgical Implant Planning Computer and Surgical RoboticSystem

FIG. 20 illustrates a block diagram of a surgical system that includes asurgical implant planning computer 2000 connected to a surgical roboticsystem 100 and which are configured to operate in accordance with someembodiments. The surgical implant planning computer 2000 can beconnected to a surgical implant device catalog server 2010 to obtaininformation that defines available types and characteristics of surgicalimplant devices, such as different dimensional bone screws, and can befurther connected to obtain images from a patient medical image server2020 and may be connected to obtain anatomical model images from amedical model image server 2030.

Referring to FIG. 20, the surgical implant planning computer 2000 allowsauto-generation of a surgical plan with respect to an initial medicalimage and/or uses a surgical plan developed by a surgeon for implantinga surgical implant device with respect to the initial medical image. Thesurgical implant planning computer 2000 automatically transforms thesurgical plan for use in implanting the surgical implant device into abone that is shown in a target medical image. The surgical implantplanning computer 2000 may provide the transformed surgical plan to thesurgical robotic system 100 to control movement of a surgicalend-effector 112 by the surgical robotic system to position the surgicalend-effector 112 relative to a location on a bone of the patient tofacilitate implantation of the surgical implant device into the bone.

In one example embodiment, a surgeon can interface with the surgicalimplant planning computer 2000 to generate a surgical plan for thelocations of bone screws on a representative scan or image (collectivelyreferred to as a “medical image”, “image scan”, and “image” for brevity)of a bone in which the screws are to be inserted. The surgical implantplanning computer 2000 can obtain an initial image of a normal spine,possibly from a subject of a specific or average height, age and weight,from the patient medical image server 2020, e.g., CT scan of a patient'sspine, or may obtain a modeled initial image of the appropriateanatomical structure from the medical model image server 2030 which mayhave images that are based on, e.g., Sawbones model by Pacific Research,Inc. A surgical plan can be generated that identifies where screws canbe implanted at any foreseeable location relative to a bone shown in theinitial image where a screw might be foreseeably needed. This surgicalplan can be generated automatically by an algorithm that considerslocations of available bony corridors through image processing, ormanually by an individual who is knowledgeable about appropriatesurgical placement of screws. For example, in an image scan of thethoracolumbosacral spine, a surgical plan can be generated by a surgeonscrolling through an image volume and marking locations that identifywhere pedicle screws could be implanted in every pedicle from T1-S3 inthe image. The initial image and the surgical plan identifyingcorresponding screw locations are stored by the surgical implantplanning computer 2000 in a local or remote memory database for laterrecall and use with a particular identified patient or, more generally,future new patients.

When a new target image for a patient is received and screw planning isneeded, the surgeon would interface with the surgical implant planningcomputer 2000 to specify where screws are to be inserted in one or moreregions of a bone shown in the target image. The computer 2000responsively obtains the initial image, the surgical plan, and thetarget image, and performs spatial transformations to morph the contoursof the initial image to sufficiently match, according to a defined rule,the contours of the target image at the specified locations. To minimizethe amount of morphing required, the initial image retrieved from thepatient medical image server 2020 or medical model image server 2030 maybe selected to match the age, gender, height, weight, ethnicity or otherparameters of the target image to provide a closer approximation.Different sections of the images could be morphed with differenttransformations so that each specific bone of interest from the initialimage sufficiently matches the target image, such as according to abest-fit operation. For example, if trying to match three levels of thelumbar spine from the initial image to the corresponding three levels inthe target image, the computer 2000 may operate to independentlytransform each vertebra of the initial image to best match eachcorresponding vertebra shown in the target image. Moreover, within abone different portions around key points could be stretched and rotateddifferently to satisfy the defined rule for conformance betweencorresponding portions in the initial and target images. Operations fortransforming, e.g., morphing, may include affine transformations, whichdo not require the body being morphed to maintain a constant aspectratio.

FIG. 21 depicts a set of images that can be displayed on a displaydevice and related operations performed by the surgical implant planningcomputer 2000 to generate a transformation matrix that transforms asurgical plan for implanting a surgical implant device relative to abone in an initial image for overlay on a bone in a target image, inaccordance with some exemplary embodiments.

Referring to FIG. 21, the images include an initial image 2100, a targetimage 2110, an initial overlaid composite view 2120 of the initial andtarget images 2100 and 2110 in which only total horizontal scaling,total vertical scaling, rotation and translation are allowed, and atransformed overlaid composite view 2130 of the target image 2110, whichhas been further asymmetrically transformed in subsets of the image tobetter conform to the initial image 2100. The initial image 2100 shows abone 2108 and an initial surgical plan for where a tip location 2106 andtail location 2104 of a surgical screw 2102 are to be located afterimplantation into the bone 2108. As explained above, the initialsurgical plan shown in initial image 2100 may have been developed by asurgeon viewing the bone 2108 in the initial image 2100 of the patientor another patient (e.g., from patient medical image server 2020) ormedical model (e.g., from medical model image server 2030), or may havebeen automatically generated by the surgical implant planning computer2000 with respect to the bone 2108 shown in the initial image 2100 whileoperating to satisfy one or more rules generated based on the surgeon'searlier defined preferences regarding screw or other device placement(preferred depth, preferred angle, etc.) relative to defined and/ordetermined characteristics of the bone 2108. The initial image 2100 isnoticeably smaller than the target image 2110 and to achieve the initialoverlay 2120 initial image 2100 is scaled so that the totalanteroposterior and lateral dimensions match those of the target image2110.

As will be explained below, the surgical implant planning computer 2000further asymmetrically transforms the implant locations within keyanatomic regions 2122 defined by the surgical plan for use with the bone2112 shown in the target image 2110 of a patient obtained by CT scan,x-ray, or other medical imaging process. The transformed implantlocations, e.g., the transformed tip and tail locations of the surgicalscrew 2132, may be provided to the surgical robotic system 100 tocontrol movement of the surgical end-effector 112 by the surgicalrobotic system 100 to position the surgical end-effector 112 relative toa bone of the patient to facilitate implantation of the surgical screw2132 in the bone.

FIGS. 22 and 23 illustrate flowcharts of operations by the surgicalimplant planning computer 2000 for generating and using a transformationmatrix for surgical planning in accordance with some exemplaryembodiments

Referring to FIGS. 21 and 22, the computer 2000 obtains 2200 the initialimage 2100 of the bone and obtains 2202 an initial location datastructure containing data defining mapping between a set of locations onthe surgical implant device, e.g., tip 2106 and tail 2104 on screw 2102,and a corresponding set of locations where they are overlaid relative tothe bone 2108 in the initial image 2100. Locations of the tip and thetail of the surgical screw 2102 relative to the bone 2108 in the initialimage 2100 can be determined based on the data in the initial locationdata structure. The type of surgical implant device and associatedlocations (e.g., tip, tail, other defined locations and/or contours)that are to be mapped to an initial image may be obtained from thesurgical implant device catalog server 2010, and the initial image maybe obtained from the medical model image server 2030 and/or the patientmedical image server 2020. The computer 2000 also obtains 2204 thetarget image 2110 of the patient's bone 2112 from the patient medicalimage server 2020.

The computer 2000 generates 2206 a transformation matrix that transformsa contour of a portion 2122 of the bone 2108 in the initial image 2100to satisfy a defined rule for conforming to a contour of a correspondingportion of the bone 2112 in the target image 2110, where an exampleportion of the overlaid images 2120 is illustrated as 2112 in FIG. 21.The transformation matrix may be generated based on how much groups ofpoints defining a surface contour of the bone 2108 in the portion 2122of the initial image 2100 need to be individually moved or collectivelystretched and/or rotated to satisfy the defined rule for conforming to acorresponding surface contour of the bone 2112 in the portion 2122 ofthe target image 2110. The defined rule may correspond to morphing thebone 2108 to achieve an optimal fit of the respective surface contoursof the bone 2112 within the portion 2122. Operations for morphinginclude, without limitation, affine transformations, which do notrequire the body being morphed to maintain a constant aspect ratio.

The overlaid composite image 2120 may be generated by transforming,e.g., stretching, the bone 2108 in the initial image 2100 toapproximately have the same overall size as the bone 2112 in the targetimage 2110. The transformed overlaid composite view 2130 may begenerated by further transforming, e.g., morphing through stretching androtating, a plurality of contours along anterior and posterior externalsurfaces and spinal canal surfaces of the bone 2108 in the initial image2110 to more closely conform to the corresponding contours of the bone2112 in the target image 2110.

The computer 2000 then generates 2208 a transformed location datastructure based on applying the transformation matrix to the initiallocation data structure of the surgical implant device, e.g., screw2102, or applying the transformation matrix to key points of the initiallocation data structure such as screw tip 2106 and screw tail 2104. Thisdistinction is made because transforming the entire screw, which crossestwo regions 2122 and 2124 that are differently transformed, could resultin a bent screw 2132 whereas transforming the tip and tail points onlyand then re-connecting these points with a straight line would result ina straight screw 2132. The computer 2000 displays 2214 on a displaydevice a graphical representation of the surgical implant device, e.g.,screw 2132, overlaid at locations on the bone 2112 in the target image2110 that are determined based on the transformed location datastructure.

In one embodiment, the surgical implant planning computer 2000 can beconfigured to display auto-planned screw locations on the target imageof the patient for the surgeon to view and adjust if needed. Thecomputer 2000 automatically determines a length of the screw based onthe known screw tip and tail coordinates defined based on dimensions ofthe bone 2108 and based on characteristic data for available screws thatis obtained from the surgical implant device catalog server 2010. Thecomputer 2000 may be configured to automatically scale the diameter ofthe screw based on the determined scaling that occurs between theoriginal screw length relative to the bone in the initial image 2100 tothe transformed screw length relative to the bone 2112 in the targetimage 2110. For example, if a 50 mm screw fit the bone 2108 in theinitial image 2100 but after transformation of the bone 2108 to conformto the bone 2112, the screw length was reduced to 40 mm, this reductionwould represent a decrease of 20% of the screw length. The computer 2000may be configured to correspondingly reduce the screw diameter by 20%.Alternatively or additionally, the computer 2000 may access a historicalrepository of data provided for a group of actual patients withdifferent lengths of screws that identifies what screw diameter wasselected for use with corresponding various lengths of screws forvarious defined regions of bone. Alternatively or additionally, thecomputer 2000 can use the known information about the locations of bonecontours of the target image 2110 which are evaluated duringtransformation of the initial image 2100 for surface conformance, theamount of space available within the region through which the screwpasses can be automatically measured and a best fitting diameter ofscrew automatically selected.

In an illustrative embodiment, the surgical screw 2102 has a tiplocation and a tail location defined by the initial location datastructure relative to the bone in the initial image, and the computer2000 scales (2210 in FIG. 22) a distance between the tip and taillocations of the surgical screw defined relative to the bone 2108 in thetarget image 2100 based on the transformation matrix. In a furtherembodiment, the computer 2000 scales (2212 in FIG. 22) a diameter of thesurgical screw based on the scaling of the distance between the tip andtail locations of the surgical screw.

As explained above, contours along key points in different portions on abone can be stretched and rotated differently to satisfy the definedrule for conformance between corresponding portions in the initial andtarget images. In FIG. 21 another portion 2124 within the overlaidimages 2120 is illustrated in which the contours of the bone 2108 can betransformed to more closely conform to the corresponding contours of thebone 2112 in the target image 2110 also within the portion 2124. Thesame or another transformation matrix can be generated or refined basedon the transformations performed within the portion 2124 of the overlaidimages 2120. For example, it may be desirable for good pedicle screwplacement to fit the initial image shape to the target image shape inthe posterior region of a vertebra in such a way that that the pediclewidths overlay while also maintaining the size of the spinal canal andoffset of pedicles from midline. Such a goal may require differentportions of the vertebra to be transformed with a differenttransformation matrix and may disallow usage of a single transformationmatrix for the entire vertebra.

A generalized method for transforming individual regions of an initialimage to match corresponding regions of a target image while maintainingcontinuity at the boundaries between regions can be applied using atechnique similar to that used to digitally create animated videos inwhich images are morphed (see for examplehttp://www.learnopencv.com/face-morph-using-opencv-cpp-python/). Thismorphing technique uses sets of points with correspondence of landmarksfrom the initial image to the target image, divides the image area orvolume into discrete regions using Delaunay Triangulation, and thenapplies affine transformations to each triangle (2D) or tetrahedron (3D)to fit each triangulated area or volume from the initial to a targetimage. In the current application, for example, to match an initialimage volume of an ideal spine to a target image volume of a newpatient's spine, key landmarks such as the spinous process, lamina,transverse process, pedicle, and vertebral body could be automaticallyidentified in initial and target images through pattern recognition andimage processing or manually identified by a user scrolling through theimage and marking these locations to create the point correspondenceset. Delaunay Triangulation and affine transformations for best fitcould be automatically generated using known techniques. The affinetransformations corresponding to the tetrahedra within which the tip andtail points lie would then be applied to the tip and tail points of ascrew. The screw body is not transformed since doing so might alter itscylindrical shape. Instead, a new screw body would be positioned usingthe transformed tip and tail points to achieve the target screw plan.

In some further embodiments, the operations for generating 2206 thetransformation matrix can include modifying a size and/or a rotationalangle of the contour of the portion of the bone 2108 in the initialimage 2100 to satisfy the defined rule for conforming to a size and/or arotational angle of the contour of the corresponding portion of the bone2112 in the target image 2110. Moreover, as explained above, theoperations can be repeated to modify the size and/or the rotationalangle of contours of a plurality of portions of the bone 2108 in theinitial image 2100 to satisfy the defined rule for conforming to thesize and/or the rotational angle of contours of a correspondingplurality of portions of the bone 2112 in the target image 2110.

In one further embodiment, the operations for modifying the size and/orthe rotational angle of the contour of the portion of the bone 2108 inthe initial image 2100, can include applying a best fit transformationof the size and/or the rotational angle of the contour of the portion ofthe bone 2108 in the initial image 2100 to satisfy the defined rule forconforming to the size and/or the rotational angle of the contour of thecorresponding portion of the bone 2112 in the target image 2110, such asshown in the overlay composite image 2120 and/or the further transformedoverlay composite image 2130. In another further embodiment, theoperations for modifying the size and/or the rotational angle of thecontour of the portion of the bone 2108 in the initial image 2100, caninclude applying an affine transformation of the size and/or therotational angle of the contour of the portion of the bone 2108 in theinitial image 2100 to satisfy the defined rule for conforming to thesize and/or the rotational angle of the contour of the correspondingportion of the bone 2112 in the target image 2110.

In a further embodiment, the operations for generating the transformedlocation data structure based on applying the transformation matrix tothe initial location data structure can include, for a first one of thelocations on the surgical implant device defined in the initial locationdata structure, applying the transformation matrix to transform acorresponding first one of the locations defined by the initial locationdata structure relative to the bone 2108 in the initial image 2100 to atransformed first location defined relative to the bone 2112 in thetarget image 2110, and storing the transformed first location in thetransformed location data structure with an association to the first oneof the locations on the surgical implant device.

The operations can further include generating another transformationmatrix that transforms a contour of another portion 2124 of the bone2108 in the initial image 2100 to satisfy the defined rule forconforming to a contour of a corresponding another portion 2124 of thebone 2112 in the target image 2110. The operations for generating thetransformed location data structure based on applying the transformationmatrix to the initial location data structure can further include, for asecond one of the locations on the surgical implant device defined inthe initial location data structure, applying the other transformationmatrix to transform a corresponding second one of the locations definedby the initial location data structure relative to the bone 2108 in theinitial image 2100 to a transformed second location defined relative tothe bone 2112 in the target image 2110, and storing the transformedsecond location in the transformed location data structure with anassociation to the second one of the locations on the surgical implantdevice.

Reference is now made to the flowchart of FIG. 23 which illustratesexample operations that can be performed to transform the mapping oflocations on the screw 2102 to the bone 2108 shown in the initial image2100 to a corresponding mapping of locations on the screw 2102 to thebone 2112 shown in the target image 2110. A first transformation matrixis generated 2300 that transforms a contour of a first portion of thebone 2108 in the initial image 2100 to satisfy a defined rule forconforming to a contour a corresponding first portion of the bone 2112in the target image 2110. The first transformation matrix is applied2302 to the tip location on the surgical screw defined in the initiallocation data structure. The transformed tip location is then stored2304 in the transformed location data structure. A second transformationmatrix is generated 2306 that transforms a contour of the second portionof the bone 2108 in the initial image 2100 to satisfy a defined rule forconforming to a contour of a corresponding second portion of the bone2112 in the target image 2110. The second transformation matrix isapplied 2308 to the tail location on the surgical screw defined in theinitial location data structure, and the transformed tail location isthen stored 2310 in the transformed location data structure.

Some scenarios can be envisioned where the operations for automaticallygenerating a surgical plan for implanting a screw or other device into apatient's bone using an anatomical model may not provide an acceptablesolution for some patients. For example, a corridor of bone can be astraight connection between locations where the tip and tail of a screwwould be positioned in the initial image (e.g., corresponding to ananatomical model or other patient), however the corresponding corridorof patient's bone in the target image of the patient may be excessivelycurved. Various such scenarios are depicted in the images of bones shownin FIG. 24, where a surgical implant device, e.g., screw, is displayedas an overlay on the bones.

Referring to FIG. 24, image 2400 illustrates a bone 2404 having astraight corridor in which a screw, rod, or other device 2402 can beimplanted. In sharp contrast, image 2410 illustrates a bone 2412 havinga substantially curved corridor in which the implant device 2402 couldbe implanted. However, it would not be medically acceptable to implantdevice 2402 where it penetrates a surface of and extends outside thebone 2412 through the curved region. In accordance with embodimentsherein, the surgical implant planning computer 2000 can be configured toidentify and compensate for such curved regions, by adjusting thelocation of the implant device 2402 to extend entirely within the bone2412. In the example of image 2420, the computer 2000 shifts inward thelocation of the implant device 2402 from location 2402′ so as to notextend outside the bone 2412 when generating the surgical plan forlocations where the device 2402 is to be implanted within the bone 2412.

FIG. 25 is a flowchart of corresponding operations that the surgicalimplant planning computer 2000 may perform to compensate for bonecurvature or other bone recesses when generating a surgical plan.Referring to FIG. 25, distances are determined 2200 between locations onthe surgical implant device defined by the transformed location datastructure and adjacent surfaces of the bone in the target image.Responsive to the determined distances, the computer 2000 adjusts 2204where the graphical representation of the surgical implant device isdisplayed as an overlay on the target image of the bone.

The operations for generating the surgical plan can include biasing orconstraining the location of the implant device based on rules that aredefined based on preferences of a surgeon. The computer 2000, may obtain2202 a set of rules defining depth of penetration of the surgicalimplant device and angle of the penetration relative to a surface of thebone in the target image, and use the set of rules to adjust 2204 wherethe graphical representation of the surgical implant device is displayedas an overlay on the target image of the bone. For example, somesurgeons may prefer to have pedicle screws at the lower lumbar level beimplanted directed straight in from posterior to anterior while othersurgeons may prefer to have the screws implanted angled inward fromlateral to medial. Alternatively or additionally, some surgeons mayprefer to have pedicle screws penetrate to 50% of the depth of thevertebral body while other surgeons may prefer to have pedicle screwspenetrate to 75% of the depth of the vertebral body. These and otherpreferences of surgeons on screw placement and other preferences forimplant devices, can be stored with the surgical plan that the surgeonmakes relative to the initial image, and which is used by the computer2000 during the transformation of the surgical plan to be directed tothe target image. The computer 2000 may enable surgeons who prefer notto go through the process of planning every foreseeable screw and/orother device implant location, to instead select from a defined set(e.g., a diagram) of possible choices that most closely match theiridentified preferences.

In this manner, a surgical system is provided that transforms anautomatically generated predictive surgical plan and/or the surgeon'sinitial surgical plan made with respect to an initial medical image to atransformed plan for use in implanting the surgical implant device intoa patient's bone that is shown in a target medical image. Such automaticplanning can reduce the time required for the surgery and increaseprecision of planning. The transformed surgical plan can be displayedfor review by the surgeon and/or can be provided to a surgical roboticsystem to control positioning of a surgical end-effector of the surgicalrobotic system relative to the bone of the patient.

Although the robot and associated systems described herein are generallydescribed with reference to spine or other bone applications, it is alsocontemplated that the surgical system is configured for use in othersurgical applications, including but not limited to, surgeries in traumaor other orthopedic applications (such as the placement ofintramedullary nails, plates, and the like), cranial, neuro,cardiothoracic, vascular, colorectal, oncological, dental, and othersurgical operations and procedures.

Components of Surgical Implant Planning Computer

FIG. 26 illustrates a block diagram of components of a surgical implantplanning computer 2000 that are configured to operate in accordance withsome exemplary embodiments. The computer 2000 can include a displaydevice 2630, a wireless and/or wired network interface circuit 2640, atleast one processor circuit 2610 (processor), and at least one memorycircuit 2620 (memory). The processor 2610 is connected to the memory2620, the display device 2630, and the network interface circuit 2640.The memory 2620 stores program code 2622 that is executed by theprocessor 2610 to perform operations. The processor 2610 may include oneor more data processing circuits, such as a general purpose and/orspecial purpose processor (e.g., microprocessor and/or digital signalprocessor), which may be collocated or distributed across one or moredata networks. The processor 2610 is configured to execute computerprogram instructions among program code 2622 in the memory 2620,described below as a computer readable medium, to perform some or all ofthe operations and methods for one or more of the embodiments disclosedherein for a surgical implant planning computer 2000. The networkinterface circuit 2640 is configured to communicate with anotherelectronic device, such as the servers 2010, 2020, and/or 2030, and thesurgical robotic system 100, through a wired network (e.g., ethernet,USB, etc.) and/or wireless network (e.g., Wi-Fi, Bluetooth, cellular,etc.).

Further Definitions and Embodiments

In the above-description of various embodiments of present inventiveconcepts, it is to be understood that the terminology used herein is forthe purpose of describing particular embodiments only and is notintended to be limiting of present inventive concepts. Unless otherwisedefined, all terms (including technical and scientific terms) usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which present inventive concepts belong. It will befurther understood that terms, such as those defined in commonly useddictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of this specification andthe relevant art and will not be interpreted in an idealized or overlyformal sense unless expressly so defined herein.

When an element is referred to as being “connected”, “coupled”,“responsive”, or variants thereof to another element, it can be directlyconnected, coupled, or responsive to the other element or interveningelements may be present. In contrast, when an element is referred to asbeing “directly connected”, “directly coupled”, “directly responsive”,or variants thereof to another element, there are no interveningelements present. Like numbers refer to like elements throughout. Unlessspecified or limited otherwise, the terms “mounted,” “connected,”“supported,” and “coupled” and variations thereof are used broadly andencompass both direct and indirect mountings, connections, supports, andcouplings. Further, “connected” and “coupled” are not restricted tophysical or mechanical connections or couplings. As used herein, thesingular forms “a”, “an” and “the” are intended to include the pluralforms as well, unless the context clearly indicates otherwise.Well-known functions or constructions may not be described in detail forbrevity and/or clarity. The term “and/or” includes any and allcombinations of one or more of the associated listed items.

It will be understood that although the terms first, second, third, etc.may be used herein to describe various elements/operations, theseelements/operations should not be limited by these terms. These termsare only used to distinguish one element/operation from anotherelement/operation. Thus a first element/operation in some embodimentscould be termed a second element/operation in other embodiments withoutdeparting from the teachings of present inventive concepts. The samereference numerals or the same reference designators denote the same orsimilar elements throughout the specification.

As used herein, the terms “comprise”, “comprising”, “comprises”,“include”, “including”, “includes”, “have”, “has”, “having”, or variantsthereof are open-ended, and include one or more stated features,integers, elements, steps, components or functions but does not precludethe presence or addition of one or more other features, integers,elements, steps, components, functions or groups thereof. Furthermore,as used herein, the common abbreviation “e.g.”, which derives from theLatin phrase “exempli gratia,” may be used to introduce or specify ageneral example or examples of a previously mentioned item, and is notintended to be limiting of such item. The common abbreviation “i.e.”,which derives from the Latin phrase “id est,” may be used to specify aparticular item from a more general recitation.

Example embodiments are described herein with reference to blockdiagrams and/or flowchart illustrations of computer-implemented methods,apparatus (systems and/or devices) and/or computer program products. Itis understood that a block of the block diagrams and/or flowchartillustrations, and combinations of blocks in the block diagrams and/orflowchart illustrations, can be implemented by computer programinstructions that are performed by one or more computer circuits. Thesecomputer program instructions may be provided to a processor circuit ofa general purpose computer circuit, special purpose computer circuit,and/or other programmable data processing circuit to produce a machine,such that the instructions, which execute via the processor of thecomputer and/or other programmable data processing apparatus, transformand control transistors, values stored in memory locations, and otherhardware components within such circuitry to implement thefunctions/acts specified in the block diagrams and/or flowchart block orblocks, and thereby create means (functionality) and/or structure forimplementing the functions/acts specified in the block diagrams and/orflowchart block(s).

These computer program instructions may also be stored in anon-transitory computer-readable medium that can direct a computer orother programmable data processing apparatus to function in a particularmanner, such that the instructions stored in the computer-readablemedium produce an article of manufacture including instructions whichimplement the functions/acts specified in the block diagrams and/orflowchart block or blocks. Accordingly, embodiments of present inventiveconcepts may be embodied in hardware and/or in software (includingfirmware, resident software, micro-code, etc.) that runs on a processorsuch as a digital signal processor, which may collectively be referredto as “circuitry,” “a module” or variants thereof.

It should also be noted that in some alternate implementations, thefunctions/acts noted in the blocks may occur out of the order noted inthe flowcharts. For example, two blocks shown in succession may in factbe executed substantially concurrently or the blocks may sometimes beexecuted in the reverse order, depending upon the functionality/actsinvolved. Moreover, the functionality of a given block of the flowchartsand/or block diagrams may be separated into multiple blocks and/or thefunctionality of two or more blocks of the flowcharts and/or blockdiagrams may be at least partially integrated. Finally, other blocks maybe added/inserted between the blocks that are illustrated, and/orblocks/operations may be omitted without departing from the scope ofinventive concepts. Moreover, although some of the diagrams includearrows on communication paths to show a primary direction ofcommunication, it is to be understood that communication may occur inthe opposite direction to the depicted arrows.

Although several embodiments of inventive concepts have been disclosedin the foregoing specification, it is understood that many modificationsand other embodiments of inventive concepts will come to mind to whichinventive concepts pertain, having the benefit of teachings presented inthe foregoing description and associated drawings. It is thus understoodthat inventive concepts are not limited to the specific embodimentsdisclosed hereinabove, and that many modifications and other embodimentsare intended to be included within the scope of the appended claims. Itis further envisioned that features from one embodiment may be combinedor used with the features from a different embodiment(s) describedherein. Moreover, although specific terms are employed herein, as wellas in the claims which follow, they are used only in a generic anddescriptive sense, and not for the purposes of limiting the describedinventive concepts, nor the claims which follow. The entire disclosureof each patent and patent publication cited herein is incorporated byreference herein in its entirety, as if each such patent or publicationwere individually incorporated by reference herein. Various featuresand/or potential advantages of inventive concepts are set forth in thefollowing claims.

What is claimed is:
 1. A method by a surgical implant planning computer for positioning a surgical implant device relative to a bone of a patient, the method comprising: obtaining an initial image of a bone; obtaining an initial location data structure containing data defining mapping between a set of locations on the surgical implant device and a corresponding set of locations relative to the bone in the initial image; obtaining a target image of the bone of the patient; generating a transformation matrix that transforms a contour of a portion of the bone in the initial image to satisfy a defined rule for conforming to a contour of a corresponding portion of the bone in the target image; generating a transformed location data structure based on applying the transformation matrix to the initial location data structure; and displaying a graphical representation of the surgical implant device overlaid at locations on the target image of the bone determined based on the transformed location data structure.
 2. The method of claim 1, wherein the surgical implant device comprises a surgical screw, and further comprising: determining locations of a tip and a tail of the surgical screw relative to the bone in the initial image based on the data in the initial location data structure.
 3. The method of claim 1, wherein the generation of the transformation matrix comprises: modifying a size and/or a rotational angle of the contour of the portion of the bone in the initial image to satisfy the defined rule for conforming to a size and/or a rotational angle of the contour of the corresponding portion of the bone in the target image.
 4. The method of claim 3, further comprising: repeating the modification of the size and/or the rotational angle of contours of a plurality of portions of the bone in the initial image to satisfy the defined rule for conforming to the size and/or the rotational angle of contours of a corresponding plurality of portions of the bone in the target image.
 5. The method of claim 3, wherein the modification of the size and/or the rotational angle of the contour of the portion of the bone in the initial image, comprises: applying a best fit transformation of the size and/or the rotational angle of the contour of the portion of the bone in the initial image to satisfy the defined rule for conforming to the size and/or the rotational angle of the contour of the corresponding portion of the bone in the target image.
 6. The method of claim 3, wherein the modification of the size and/or the rotational angle of the contour of the portion of the bone in the initial image, comprises: applying an affine transformation of the size and/or the rotational angle of the contour of the portion of the bone in the initial image to satisfy the defined rule for conforming to the size and/or the rotational angle of the contour of the corresponding portion of the bone in the target image.
 7. The method of claim 1, wherein the generation of the transformed location data structure based on applying the transformation matrix to the initial location data structure, comprises: for a first one of the locations on the surgical implant device defined in the initial location data structure, applying the transformation matrix to transform a corresponding first one of the locations defined by the initial location data structure relative to the bone in the initial image to a transformed first location defined relative to the bone in the target image; and storing the transformed first location in the transformed location data structure with an association to the first one of the locations on the surgical implant device.
 8. The method of claim 7, further comprising: generating another transformation matrix that transforms a contour of another portion of the bone in the initial image to satisfy the defined rule for conforming to a contour of a corresponding another portion of the bone in the target image, wherein the generation of the transformed location data structure based on applying the transformation matrix to the initial location data structure, further comprises: for a second one of the locations on the surgical implant device defined in the initial location data structure, applying the other transformation matrix to transform a corresponding second one of the locations defined by the initial location data structure relative to the bone in the initial image to a transformed second location defined relative to the bone in the target image; and storing the transformed second location in the transformed location data structure with an association to the second one of the locations on the surgical implant device.
 9. The method of claim 7, wherein: the surgical implant device comprises a surgical screw having a tip location and a tail location defined in the initial location data structure relative to the bone in the initial image; and the generation of the transformed location data structure based on applying the transformation matrix to the initial location data structure, comprises: generating a first transformation matrix that transforms a contour of a first portion of the bone in the initial image to satisfy the defined rule for conforming to a contour of a corresponding first portion of the bone in the target image; for the tip location on the surgical screw defined in the initial location data structure, applying the first transformation matrix to transform a corresponding first location defined by the initial location data structure relative to the bone in the initial image to a transformed first location defined relative to the bone in the target image; storing the transformed first location in the transformed location data structure with an association to the tip location on the surgical screw; generating a second transformation matrix that transforms a contour of a second portion of the bone in the initial image to satisfy the defined rule for conforming to a contour of a corresponding second portion of the bone in the target image, for the tail location on the surgical screw defined in the initial location data structure, applying the second transformation matrix to transform a corresponding second location defined by the initial location data structure relative to the bone in the initial image to a transformed second location defined relative to the bone in the target image; and storing the transformed second location in the transformed location data structure with an association to the tail location on the surgical screw.
 10. The method of claim 1, wherein: the surgical implant device comprises a surgical screw having a tip location and a tail location defined by the initial location data structure relative to the bone in the initial image; and the generation of the transformed location data structure based on applying the transformation matrix to the initial location data structure, comprises scaling a distance between the tip and tail locations of the surgical screw defined relative to the bone in the target image based on the transformation matrix.
 11. The method of claim 10, wherein the generation of the transformed location data structure based on applying the transformation matrix to the initial location data structure, further comprises: scaling a diameter of the surgical screw based on the scaling of the distance between the tip and tail locations of the surgical screw.
 12. The method of claim 1, further comprising: providing the transformed location data structure to a surgical robotic system to control positioning of a surgical end-effector of the surgical robotic system relative to a location on the bone of the patient based on data of the transformed location data structure.
 13. The method of claim 12, further comprising: transforming locations that are defined by the transformed location data structure in a reference coordinate system of the target image of the bone to another reference coordinate system of the surgical end-effector; controlling movement by the surgical robotic system of the surgical end-effector to position the surgical end-effector relative to the location on the bone of the patient based on the transformed locations to facilitate implantation of the surgical implant device in the bone of the patient.
 14. The method of claim 1, further comprising: determining distances between locations on the surgical implant device defined by the transformed location data structure and adjacent surfaces of the bone in the target image; and responsive to the determined distances, adjusting where the graphical representation of the surgical implant device is displayed as an overlay on the target image of the bone.
 15. The method of claim 1, further comprising: obtaining a set of rules defining depth of penetration of the surgical implant device and angle of the penetration relative to a surface of the bone in the target image; and responsive to the set of rules, adjusting where the graphical representation of the surgical implant device is displayed as an overlay on the target image of the bone.
 16. A surgical implant planning computer comprising: at least one network interface connected to at least one networked server; a display device; at least one processor connected to the at least one network interface and the display device; and at least one memory storing program instructions executed by the at least one processor to perform operations comprising: obtaining an initial image of a bone through the at least one network interface from the at least one server; obtaining an initial location data structure containing data defining mapping between a set of locations on the surgical implant device and a corresponding set of locations relative to the bone in the initial image, through the at least one network interface from the at least one server; obtaining a target image of the bone of the patient through the at least one network interface from the at least one server; generating a transformation matrix that transforms a contour of a portion of the bone in the initial image to satisfy a defined rule for conforming to a contour of a corresponding portion of the bone in the target image; generating a transformed location data structure based on applying the transformation matrix to the initial location data structure; and displaying on the display device a graphical representation of the surgical implant device overlaid at locations on the target image of the bone determined based on the transformed location data structure.
 17. The surgical implant planning computer of claim 16, wherein: the surgical implant device comprises a surgical screw having a tip location and a tail location defined by the initial location data structure relative to the bone in the initial image; and the generation of the transformed location data structure based on applying the transformation matrix to the initial location data structure, comprises scaling a distance between the tip and tail locations of the surgical screw defined relative to the bone in the target image based on the transformation matrix.
 18. The surgical implant planning computer of claim 16, wherein the operations further comprise: providing the transformed location data structure through the at least one network interface to a surgical robotic system to control positioning of a surgical end-effector of the surgical robotic system relative to a location on the bone of the patient based on data of the transformed location data structure.
 19. A surgical system comprising: a surgical implant planning computer comprising: at least one network interface connected to at least one networked server; a display device; at least one processor connected to the at least one network interface and the display device; and at least one memory storing program instructions executed by the at least one processor to perform operations comprising: obtaining an initial image of a bone through the at least one network interface from the at least one server; obtaining an initial location data structure containing data defining mapping between a set of locations on the surgical implant device and a corresponding set of locations relative to the bone in the initial image, through the at least one network interface from the at least one server; obtaining a target image of the bone of the patient through the at least one network interface from the at least one server; generating a transformation matrix that transforms a contour of a portion of the bone in the initial image to satisfy a defined rule for conforming to a contour of a corresponding portion of the bone in the target image; generating a transformed location data structure based on applying the transformation matrix to the initial location data structure; and displaying on the display device a graphical representation of the surgical implant device overlaid at locations on the target image of the bone determined based on the transformed location data structure; and a surgical robotic system comprising: a robotic arm configured to position a surgical end-effector; and a controller connected to the robotic arm, wherein the controller is configured to perform operations comprising: transforming locations that are defined by the transformed location data structure in a reference coordinate system of the target image of the bone to another reference coordinate system of the surgical end-effector; and controlling movement of the surgical end-effector to position the surgical end-effector relative to a location on the bone of the patient based on the transformed locations to facilitate implantation of the surgical implant device in the bone of the patient.
 20. The surgical system of claim 19, wherein: the surgical implant device comprises a surgical screw having a tip location and a tail location defined by the initial location data structure relative to the bone in the initial image; the operation of generating the transformed location data structure based on applying the transformation matrix to the initial location data structure, comprises scaling a distance between the tip and tail locations of the surgical screw defined relative to the bone in the target image based on the transformation matrix; and the operation of controlling movement of the surgical end-effector to position the surgical end-effector relative to a location on the bone of the patient based on the transformed locations to facilitate implantation of the surgical implant device in the bone of the patient. 